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American Journal of Neuroradiology 28:1409-1414, August 2007
DOI 10.3174/ajnr.A0547
© 2007 American Society of Neuroradiology

INTERVENTIONAL

Embolization of High-Flow Craniofacial Vascular Malformations with Onyx

A. Arata, B.E. Cilc, I. Vargeld, B. Turkbeyc, M. Canyigitc, B. Peynirciogluc and Y.O. Aratb

a Department of Radiology, Baylor College of Medicine, Houston, Tex
b Department of Ophthalmology, Baylor College of Medicine, Houston, Tex
c Department of Radiology, Hacettepe University Hospitals, Ankara, Turkey
d Department of Plastic/Reconstructive Surgery, Kirikkale University, Kirikkale, Turkey

Please address correspondence to Anil Arat, Department of Radiology, Baylor College of Medicine, 1 Baylor Plaza, Suite 165 B, Houston, TX 77030; e-mail: anilarat{at}netscape.net

BACKGROUND AND PURPOSE: Various techniques and materials have been used for the endovascular treatment of craniofacial high-flow arteriovenous vascular malformations, because their rarity precludes standardization of their treatment. The aim of this retrospective review is to assess Onyx as the primary embolic agent in the treatment of these vascular malformations.

MATERIALS AND METHODS: Six patients with arteriovenous fistulas and 3 with arteriovenous malformations (AVMs) of the head and neck region were treated with intra-arterial (IA)/direct percutaneous injections of Onyx. Adjunctive maneuvers used during embolization included external compression of the arterial feeders or venous outflow (6 patients), balloon assist (4 patients), and direct embolization of the draining vein remote to the fistula site (1 patient). n-butyl-2-cyanoacrylate (n-BCA) was used in addition to Onyx for rapid induction of thrombosis in a large venous pouch (1 patient) and for cost containment purposes (1 patient). Four patients were treated surgically after the embolization.

RESULTS: There were no neurologic complications secondary to the embolization procedure. The arteriovenous shunt was eliminated in all of the fistulous lesions and 2 of the 3 AVMs. The embolization was incomplete in 1 patient with a large AVM who declined further endovascular or surgical procedures. Untoward events included 2 instances of catheter entrapment (of 9 IA injections), blackish skin discoloration necessitating surgical revision in 1 patient, and difficulty of balloon deflation/wire withdrawal during a balloon-assisted embolization.

CONCLUSION: Onyx appears to be a safe and effective liquid embolic agent for use in the treatment of craniofacial high-flow vascular malformations with distinct advantages and disadvantages compared with n-BCA.




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Copyright © 2008 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X