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Resection of a posterior fossa arteriovenous malformation complicated by leaked Onyx: a case report and review of literature.
Acta Neurochirurgica ( IF 2.4 ) Pub Date : 2020-01-30 , DOI: 10.1007/s00701-019-04199-3
Elena Solli 1 , Fareed Jumah 1 , Vinayak Narayan 1 , Travis Quinoa 1 , Zhenggang Xiong 2 , Gaurav Gupta 1 , Enmar Alharfoush 1 , Anil Nanda 1
Affiliation  

Extravasation of Onyx is a rare complication during embolization of arteriovenous malformations (AVM). We present a case of embolization that was complicated by leakage of Onyx into the cerebellum which was later encountered during surgical excision of the AVM. Our goal is to report this rare event and to outline successful treatment of this complication. The patient's records were reviewed for medical history, laboratory and radiologic workup, and outpatient clinical follow-up. A 62-year-old female presented with Hunt Hess grade 2 and modified Fisher grade 2 subarachnoid hemorrhage (SAH) secondary to ruptured left posterior inferior cerebellar artery (PICA) aneurysm associated with a superior cerebellar vermian AVM. Following endovascular intervention, the aneurysm was completely embolized; however, only 75% of the AVM could be safely obliterated. Extravasation of Onyx from the ruptured aneurysm was noted on her initial angiogram. Elective suboccipital craniectomy was subsequently planned for resection of the residual AVM where the extravasated Onyx posed an operative nuisance during resection. Post-op angiogram confirmed complete resection of the AVM, as well as the bulk of the extravasated Onyx. Patient did well post-operatively, remaining neurologically intact throughout her hospital course. Although infrequently reported in the literature, Onyx extravasation is a potential complication that neurosurgeons should be ready to face. Adherence of Onyx to surrounding parenchyma could hinder optimal surgical resection of AVM and increase complications. Therefore, careful surgical dissection should be performed with special care to delicate neurovasculature. In this case, complete resection of the AVM and Onyx mass was safely achieved.

中文翻译:

后颅窝动静脉畸形并发缟玛瑙漏出的切除术:1例报告并文献复习。

Onyx 的外渗是动静脉畸形 (AVM) 栓塞期间的罕见并发症。我们介绍了一个因 Onyx 渗漏到小脑而复杂化的栓塞病例,后来在 AVM 的手术切除过程中遇到了这种情况。我们的目标是报告这一罕见事件并概述这种并发症的成功治疗方法。对患者的病史记录、实验室和放射检查以及门诊临床随访进行了审查。一名 62 岁女性出现 Hunt Hess 2 级和改良 Fisher 2 级蛛网膜下腔出血 (SAH),继发于与小脑上蚓部 AVM 相关的左小脑后下动脉 (PICA) 破裂动脉瘤。血管内介入治疗后,动脉瘤完全栓塞;然而,只有 75% 的 AVM 可以安全地消除。在她最初的血管造影照片上注意到从破裂的动脉瘤中渗出的玛瑙。随后计划进行选择性枕下颅骨切除术以切除残留的 AVM,其中外渗的 Onyx 在切除过程中造成手术障碍。术后血管造影证实 AVM 以及大部分外渗的 Onyx 完全切除。患者术后恢复良好,在整个住院过程中神经系统保持完好。尽管文献中很少报道,但缟玛瑙外渗是神经外科医生应该准备好面对的潜在并发症。Onyx 对周围实质的粘附可能会阻碍 AVM 的最佳手术切除并增加并发症。所以,应特别小心地对脆弱的神经血管系统进行仔细的外科解剖。在这种情况下,安全地实现了 AVM 和 Onyx 肿块的完全切除。
更新日期:2020-04-03
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