Department of Neurosurgery, Rutgers-Robert Wood Johnson Medical School and University Hospital, New Brunswick, NJ, USA.
Department of Pathology, Laboratory Medicine Robert Wood Johnson Medical School and University Hospital-Rutgers, New Brunswick, NJ, USA.
Acta Neurochir (Wien). 2020 Apr;162(4):923-928. doi: 10.1007/s00701-019-04199-3. Epub 2020 Jan 30.
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.
胶外渗是动静脉畸形（AVM）栓塞治疗中罕见的并发症。我们报告了一例因胶外渗进入小脑而导致栓塞复杂化的病例，该病例在 AVM 手术切除过程中被发现。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。回顾了患者的病历，包括病史、实验室和影像学检查以及门诊临床随访。一名 62 岁女性因左侧后下小脑动脉（PICA）破裂伴小脑上蚓部动静脉畸形（AVM）破裂而出现 Hunt Hess 分级 2 级和改良 Fisher 分级 2 级蛛网膜下腔出血（SAH）。血管内介入治疗后，动脉瘤完全栓塞，但仅能安全地闭塞 75%的 AVM。在她的初始血管造影上发现胶外渗从破裂的动脉瘤中渗出。随后计划进行选择性枕下颅骨切除术，以切除残留的 AVM，其中外渗的胶外渗在切除过程中造成了手术麻烦。术后血管造影证实 AVM 完全切除，以及大部分外渗的胶外渗。患者术后恢复良好，整个住院期间神经功能完整。尽管在文献中报道较少，但胶外渗是神经外科医生应该准备面对的潜在并发症。胶外渗对周围实质的黏附可能会阻碍 AVM 的最佳手术切除，并增加并发症。因此，应进行仔细的手术解剖，特别注意精细的神经血管结构。在本例中，成功地安全切除了 AVM 和胶外渗块。
