de Los Reyes K, Patel A, Doshi A, Egorova N, Panov F, Bederson J B, Frontera J A
Department of Neurosurgery and Neurology, Mount Sinai School of Medicine, New York, NY, USA.
Interv Neuroradiol. 2011 Sep;17(3):331-8. doi: 10.1177/159101991101700308. Epub 2011 Oct 17.
Onyx embolization of cerebral arteriovenous malformations (AVM) has become increasingly common. We explored the risk of seizures after Onyx use.A retrospective review was conducted of 20 patients with supratentorial brain arteriovenous malformation (AVM) who received Onyx embolization between 2006 and 2009. Baseline demographics, clinical history, seizure history, AVM characteristics and treatment were compared between those who developed post-onyx seizure and those who did not. MRIs were reviewed for edema following Onyx treatment.Of 20 patients who underwent Onyx embolization, the initial AVM presentation was hemorrhage in 40% (N=8). The median number of embolizations was two (range 1-4) and the median final obliteration amount was 90% (range 50-100%). A history of seizure was present in 50% (N=10) of patients pre-embolization and 12 (60%) patients received seizure medications (treatment or prophylaxis) prior to embolization. Seizur post-Onyx embolization occurred in 45% (N=9). The median time to seizur post-Onyx was seven days (range 0.3-210). Four patients (20%) with seizures post-Onyx had no seizure history. Two of these patients (10%) had no other identifiable cause for seizure other than recent Onyx embolization. Seizures in these two patients occurred within 24 hours of Onyx administration. Among patients with post-Onyx seizures, there was a trend toward larger AVM size (P=0.091) and lower percent obliteration (P=0.062). Peri-AVM edema was present in 75% of MRIs performed within one month of Onyx treatment and may represent a possible etiology for seizures.New onset seizures post-Onyx embolization are not uncommon. Further study of seizure prevention is warranted.
使用Onyx栓塞脑动静脉畸形（AVM）已变得越来越普遍。我们探讨了使用Onyx后癫痫发作的风险。对2006年至2009年间接受Onyx栓塞治疗的20例幕上脑动静脉畸形（AVM）患者进行了回顾性研究。比较了发生Onyx后癫痫发作的患者和未发生癫痫发作的患者的基线人口统计学、临床病史、癫痫病史、AVM特征及治疗情况。对Onyx治疗后的MRI进行水肿情况评估。在接受Onyx栓塞治疗的20例患者中，最初AVM表现为出血的占40%（n = 8）。栓塞次数中位数为2次（范围1 - 4次），最终闭塞率中位数为90%（范围50% - 100%）。50%（n = 10）的患者在栓塞前有癫痫病史，12例（60%）患者在栓塞前接受了抗癫痫药物治疗（治疗或预防）。Onyx栓塞后癫痫发作发生在45%（n = 9）的患者中。Onyx后癫痫发作的中位时间为7天（范围0.3 - 210天）。4例（20%）Onyx后癫痫发作的患者既往无癫痫病史。其中2例患者（10%）除近期Onyx栓塞外无其他可识别的癫痫发作原因。这2例患者的癫痫发作发生在Onyx给药后24小时内。在发生Onyx后癫痫发作的患者中，有AVM体积较大（P = 0.091）和闭塞率较低（P = 0.062）的趋势。在Onyx治疗后1个月内进行的MRI检查中，75%发现AVM周围有水肿，这可能是癫痫发作的一个可能病因。Onyx栓塞后新发癫痫发作并不少见。有必要进一步研究癫痫预防。
