Department of Neurological Surgery, University of Miami Miller School of Medicine, Lois Pope LIFE Center, Miami, Florida 33136-1060, USA.
Neurosurgery. 2012 Oct;71(4):773-84. doi: 10.1227/NEU.0b013e3182648db6.
Although Onyx is widely used to embolize vascular lesions in adults, the safety and efficacy of this liquid embolic agent for use in children are not well studied.
To report our experience using Onyx in pediatric patients for a variety of cranial and spinal vascular lesions and tumors to determine its procedural complication rates, types, and clinical consequences and to highlight the indications for and principles of Onyx embolization in pediatric patients.
All pediatric Onyx embolization cases performed consecutively by the neuroendovascular services at our 2 institutions over a 5-year period were collected retrospectively and analyzed.
Over the study period, 105 Onyx embolization procedures were performed in 69 pediatric patients with a mean follow-up of 112 days. Fifty-two patients harbored "primary" vascular lesions (malformations, fistulas, etc), whereas 17 patients had tumors. Complications occurred in 25 of 105 procedures (23.8%) and included ischemic infarct (7), asymptomatic nontarget embolization (4), intracerebral hemorrhage (3), microcatheter-related vessel perforation (3), retained microcatheter (2), cerebral edema (2), dimethyl sulfoxide-induced pulmonary edema (2), facial ischemia (1), and contrast-induced bronchospasm (1). Neurological morbidity occurred transiently after 10 procedures (9.5%) and permanently after 2 procedures (1.9%). There were no procedure-related deaths. Statistical analysis revealed no predictors of complications among the multiple potential risk factors evaluated.
Our experience suggests that Onyx can be used effectively for embolization of pediatric cranial and spinal vascular lesions and tumors with low permanent morbidity; however, attention must be paid to the technical nuances of and indications for its use to avoid potential complications.
尽管 Onyx 已广泛用于成人血管病变的栓塞治疗，但该液体栓塞剂在儿童中的安全性和疗效尚未得到充分研究。
报告我们使用 Onyx 治疗各种颅脊血管病变和肿瘤的经验，以确定其操作并发症的发生率、类型和临床后果，并强调在儿童中使用 Onyx 栓塞的适应证和原则。
回顾性收集了 2 家机构神经介入服务部门在 5 年内连续进行的所有儿童 Onyx 栓塞病例，并进行分析。
在研究期间，69 名儿童共进行了 105 次 Onyx 栓塞术，平均随访 112 天。52 例患儿存在“原发性”血管病变（畸形、瘘等），17 例患儿患有肿瘤。105 次操作中有 25 次（23.8%）发生并发症，包括缺血性梗死（7 例）、无症状非靶血管栓塞（4 例）、颅内出血（3 例）、微导管相关血管穿孔（3 例）、微导管残留（2 例）、脑水肿（2 例）、二甲基亚砜诱导的肺水肿（2 例）、面部缺血（1 例）和对比剂诱导的支气管痉挛（1 例）。10 次操作后出现短暂性神经功能障碍（9.5%），2 次操作后出现永久性神经功能障碍（1.9%）。无与操作相关的死亡病例。统计学分析显示，在所评估的多个潜在危险因素中，并发症无预测因素。
我们的经验表明，Onyx 可有效用于儿童颅脊血管病变和肿瘤的栓塞治疗，永久性并发症发生率低；但必须注意使用的技术细节和适应证，以避免潜在并发症。
