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Incidental occlusion of anterior spinal artery due to Onyx reflux in embolization of spinal type II arteriovenous malformation.
Eur Spine J. 2017 05; 26(Suppl 1):75-79.ES

Abstract

PURPOSE

Onyx embolization is one of the standard treatments for brain arteriovenous malformations (AVMs) and is a promising method for spinal AVMs as well. Its advantages have been emphasized, and few complications have been reported with Onyx embolization in spinal AVMs. Here, we report an incidental anterior spinal artery (ASA) occlusion due to Onyx reflux during embolization of a spinal type II AVM.

METHODS

A 15-year-old boy presented with weakness in both upper and lower extremities. Magnetic resonance imaging and spinal angiogram revealed a spinal type II AVM with two feeders including the right vertebral artery (VA) and the right deep cervical artery.

RESULTS

Onyx embolization was performed gradually from the VA to the deep cervical artery and an unexpected Onyx reflux to the ASA was observed during the latter stage deep cervical artery embolization. Post-operative quadriplegia and low cranial nerves (CN) dysfunction were observed. Rehabilitation treatment was performed and the patient showed marked improvement of neurologic deterioration at 1-year follow-up.

CONCLUSIONS

Onyx is an effective treatment choice for spinal AVMs. However, due to the small vasculature of the spine compared to the brain, the nidus is rapidly packed with a small amount of Onyx, which allows Onyx reflux to unexpected vessels. Extreme caution is required and dual-lumen balloon catheter could be considered for Onyx embolization in spinal AVMs treatment.

Links

Publisher Full Text (DOI)

Authors+Show Affiliations

Kim J
Department of Neurosurgery, College of Medicine, Korea University Anam Hospital, 73, Inchon-ro, Seongbuk-gu, Seoul, 02841, South Korea.
Lee JB
Department of Neurosurgery, College of Medicine, Korea University Anam Hospital, 73, Inchon-ro, Seongbuk-gu, Seoul, 02841, South Korea.
Cho TH
Department of Neurosurgery, College of Medicine, Korea University Anam Hospital, 73, Inchon-ro, Seongbuk-gu, Seoul, 02841, South Korea.
Hur JW
Department of Neurosurgery, College of Medicine, Korea University Anam Hospital, 73, Inchon-ro, Seongbuk-gu, Seoul, 02841, South Korea. hurjune@gmail.com.

MeSH

AdolescentAngiographyArteriovenous MalformationsCentral Nervous System Vascular MalformationsEmbolization, TherapeuticHumansMagnetic Resonance ImagingMalePostoperative ComplicationsPostoperative PeriodQuadriplegiaSpinal CordSpinal Cord IschemiaTreatment OutcomeVertebral Artery

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

27671278

Citation

Kim, Joohyun, et al. "Incidental Occlusion of Anterior Spinal Artery Due to Onyx Reflux in Embolization of Spinal Type II Arteriovenous Malformation." European Spine Journal : Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, vol. 26, no. Suppl 1, 2017, pp. 75-79.
Kim J, Lee JB, Cho TH, et al. Incidental occlusion of anterior spinal artery due to Onyx reflux in embolization of spinal type II arteriovenous malformation. Eur Spine J. 2017;26(Suppl 1):75-79.
Kim, J., Lee, J. B., Cho, T. H., & Hur, J. W. (2017). Incidental occlusion of anterior spinal artery due to Onyx reflux in embolization of spinal type II arteriovenous malformation. European Spine Journal : Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 26(Suppl 1), 75-79. https://doi.org/10.1007/s00586-016-4767-y
Kim J, et al. Incidental Occlusion of Anterior Spinal Artery Due to Onyx Reflux in Embolization of Spinal Type II Arteriovenous Malformation. Eur Spine J. 2017;26(Suppl 1):75-79. PubMed PMID: 27671278.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Incidental occlusion of anterior spinal artery due to Onyx reflux in embolization of spinal type II arteriovenous malformation. AU - Kim,Joohyun, AU - Lee,Jang-Bo, AU - Cho,Tai-Hyoung, AU - Hur,Junseok W, Y1 - 2016/09/26/ PY - 2016/08/02/received PY - 2016/09/01/accepted PY - 2016/9/28/pubmed PY - 2018/2/10/medline PY - 2016/9/28/entrez KW - Anterior spinal artery KW - Arteriovenous malformation KW - Embolization KW - Onyx KW - Reflux SP - 75 EP - 79 JF - European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society JO - Eur Spine J VL - 26 IS - Suppl 1 N2 - PURPOSE: Onyx embolization is one of the standard treatments for brain arteriovenous malformations (AVMs) and is a promising method for spinal AVMs as well. Its advantages have been emphasized, and few complications have been reported with Onyx embolization in spinal AVMs. Here, we report an incidental anterior spinal artery (ASA) occlusion due to Onyx reflux during embolization of a spinal type II AVM. METHODS: A 15-year-old boy presented with weakness in both upper and lower extremities. Magnetic resonance imaging and spinal angiogram revealed a spinal type II AVM with two feeders including the right vertebral artery (VA) and the right deep cervical artery. RESULTS: Onyx embolization was performed gradually from the VA to the deep cervical artery and an unexpected Onyx reflux to the ASA was observed during the latter stage deep cervical artery embolization. Post-operative quadriplegia and low cranial nerves (CN) dysfunction were observed. Rehabilitation treatment was performed and the patient showed marked improvement of neurologic deterioration at 1-year follow-up. CONCLUSIONS: Onyx is an effective treatment choice for spinal AVMs. However, due to the small vasculature of the spine compared to the brain, the nidus is rapidly packed with a small amount of Onyx, which allows Onyx reflux to unexpected vessels. Extreme caution is required and dual-lumen balloon catheter could be considered for Onyx embolization in spinal AVMs treatment. SN - 1432-0932 UR - https://www.unboundmedicine.com/medline/citation/27671278/Incidental_occlusion_of_anterior_spinal_artery_due_to_Onyx_reflux_in_embolization_of_spinal_type_II_arteriovenous_malformation_ DB - PRIME DP - Unbound Medicine ER -