Incidental occlusion of anterior spinal artery due to Onyx reflux in embolization of spinal type II arteriovenous malformation

Joohyun Kim; Jang-Bo Lee; Tai-Hyoung Cho; Junseok W Hur

doi:10.1007/s00586-016-4767-y

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Incidental occlusion of anterior spinal artery due to Onyx reflux in embolization of spinal type II arteriovenous malformation

Journal article

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Peer reviewed

Incidental occlusion of anterior spinal artery due to Onyx reflux in embolization of spinal type II arteriovenous malformation

Joohyun Kim, Jang-Bo Lee, Tai-Hyoung Cho and Junseok W Hur

European spine journal, Vol.26(Suppl 1), pp.75-79

05/01/2017

DOI: 10.1007/s00586-016-4767-y

PMID: 27671278

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Abstract

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. 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. 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. 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.

Angiography

Magnetic Resonance Imaging

Adolescent

Arteriovenous Malformations - diagnostic imaging

Arteriovenous Malformations - therapy

Central Nervous System Vascular Malformations - diagnostic imaging

Central Nervous System Vascular Malformations - therapy

Embolization, Therapeutic - adverse effects

Humans

Male

Postoperative Complications - diagnostic imaging

Postoperative Complications - etiology

Postoperative Complications - rehabilitation

Postoperative Period

Quadriplegia - etiology

Quadriplegia - rehabilitation

Spinal Cord - blood supply

Spinal Cord Ischemia - diagnostic imaging

Spinal Cord Ischemia - etiology

Spinal Cord Ischemia - rehabilitation

Treatment Outcome

Vertebral Artery

Details

Title: Subtitle: Incidental occlusion of anterior spinal artery due to Onyx reflux in embolization of spinal type II arteriovenous malformation
Creators: Joohyun Kim - Korea University Medical Center
Jang-Bo Lee - Korea University Medical Center
Tai-Hyoung Cho - Korea University Medical Center
Junseok W Hur - Korea University Medical Center
Resource Type: Journal article
Publication Details: European spine journal, Vol.26(Suppl 1), pp.75-79
DOI: 10.1007/s00586-016-4767-y
PMID: 27671278
ISSN: 0940-6719
eISSN: 1432-0932
Language: English
Date published: 05/01/2017
Academic Unit: Neurosurgery
Record Identifier: 9984460337602771

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