Delayed Migration of Onyx Embolic Agent after Preoperative Embolization of an Arteriovenous Malformation in a Pediatric Patient: A Case Report and Review of the Literature.

IF 0.9 4区医学 Q4 CLINICAL NEUROLOGY

Pediatric Neurosurgery Pub Date : 2023-01-01 DOI:10.1159/000529629

Bailey R Nussbaum, Patrick Graupman, Collin M Torok, Tiffany A Yesavage, Eric S Nussbaum

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引用次数: 0

Abstract

Introduction: Brain arteriovenous malformations (AVMs) are increasingly being treated with Onyx liquid embolic agent (Onyx, Medtronic, Inc.). The phenomenon of delayed Onyx migration is not well documented in the literature. Moreover, the clinical presentation associated with Onyx migration is not well understood.

Case presentation: A pediatric patient with a history of neonatal seizures was referred to our institution upon experiencing daily headaches with photophobia, phonophobia, and sleep disturbance. Cerebral angiography revealed an AVM of the medial left cerebellar hemisphere. Preoperative embolization with Onyx liquid embolic achieved 25% closure of the AVM nidus. Upon developing worsening headaches the following day, new perinidal parenchymal edema was revealed on MRI, and urgent angiography demonstrated delayed migration of Onyx into the venous drainage. The patient underwent emergency resection of the AVM due to the risk of hemorrhage resulting from venous outflow obstruction.

Conclusion: Our report and literature review demonstrate that while the delayed, unexpected migration of Onyx embolic material has been alluded to in a handful of papers, this phenomenon is not well documented. Future research is needed to understand the frequency of delayed Onyx migration from brain AVMs and the possible clinical presentations to look for. The sudden development of headaches and other signs of perilesional edema, in particular, should prompt repeat angiographic examination due to the possibility of delayed liquid embolic migration.

查看原文本刊更多论文

小儿动静脉畸形术前栓塞后玛瑙栓剂的延迟迁移:1例报告及文献回顾。

简介:脑动静脉畸形(avm)越来越多地使用Onyx液体栓塞剂(Onyx, Medtronic, Inc.)治疗。延迟的玛瑙迁移现象在文献中没有很好的记录。此外，与玛瑙迁移相关的临床表现尚不清楚。病例介绍:一名有新生儿癫痫史的儿童患者因每日头痛、畏光、恐音和睡眠障碍而被转介到我们的机构。脑血管造影显示左小脑半球内侧AVM。术前使用缟玛瑙液体栓塞术栓塞AVM病灶达到25%闭合。第二天头痛加重，MRI显示新的腹膜实质水肿，紧急血管造影显示Onyx向静脉引流延迟迁移。由于静脉流出梗阻导致出血的危险，患者接受了紧急切除动静脉畸形。结论:我们的报告和文献综述表明，虽然在少数论文中提到了玛瑙栓塞物质的延迟，意外迁移，但这种现象并没有得到很好的记录。需要进一步的研究来了解脑动静脉畸形迟发性缟玛石迁移的频率以及可能的临床表现。特别是突然出现头痛和其他病灶周围水肿的迹象时，由于可能存在延迟的液体栓塞迁移，应提示再次进行血管造影检查。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Pediatric Neurosurgery 医学-临床神经学

CiteScore

1.30

自引率

0.00%

发文量

审稿时长

>12 weeks

期刊介绍： Articles in ''Pediatric Neurosurgery'' strives to publish new information and observations in pediatric neurosurgery and the allied fields of neurology, neuroradiology and neuropathology as they relate to the etiology of neurologic diseases and the operative care of affected patients. In addition to experimental and clinical studies, the journal presents critical reviews which provide the reader with an update on selected topics as well as case histories and reports on advances in methodology and technique. This thought-provoking focus encourages dissemination of information from neurosurgeons and neuroscientists around the world that will be of interest to clinicians and researchers concerned with pediatric, congenital, and developmental diseases of the nervous system.