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AJNR - American Journal of Neuroradiology

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Fatal Ethibloc Embolization of Vertebrobasilar System following Percutaneous Injection into Aneurysmal Bone Cyst of the Second Cervical Vertebra

A. Peraud^a, J. M. Drake^a, D. Armstrong^c, D. Hedden^d, P. Babyn^c and G. Wilson^b

^a Division of Neurosurgery, Hospital for Sick Children, Toronto, Canada
^b Division of Pathology and Cardiovascular Research, Hospital for Sick Children, Toronto, Canada
^c Division of Diagnostic Imaging/Interventional Radiology, Hospital for Sick Children, Toronto, Canada
^d Division of Orthopedics, Hospital for Sick Children, Toronto, Canada

View larger version (78K): [in a new window]   FIG 1. Lateral (A) and open-mouth odontoid (B) conventional radiographs of the cervical spine show the osteodestructive lesion in C2.

View larger version (61K): [in a new window]   FIG 2. Preinterventional postgadolinium T1-weighted MR images of the cervical spine in the axial (A), sagittal (B), and coronal (C) planes show an irregular, enhancing, expansile lesion in the body and the lamina of C2 surrounding the right (dominant) vertebral artery.

View larger version (72K): [in a new window]   FIG 3. 3D CT planning and reconstruction scan (A) of the upper cervical spine depicts the multicystic lesion and superimposed C1 (green) as well as the vertebral arteries (red). The trajectory of the biopsy needle can be seen in three subsequent axial CT scans (B).

View larger version (90K): [in a new window]   FIG 4. Postinterventional CT scans of the head with Ethibloc filling of the vertebrobasilar system (A), causing cerebellar and brain stem infarction. Signal intensity changes in the brain stem and the cerebellum, cerebellar swelling with brain stem compression, and up- and downward herniation are shown on axial FLAIR, sagittal T1-weighted, and coronal T2-weighted MR images (B).

View larger version (153K): [in a new window]   FIG 5. Histopathologic section from autopsy shows Ethibloc (purple staining material) together with recent thrombus filling a side branch of the right vertebral artery (RVA). The side branch is distended, with necrosis of the arterial wall (arrows). Osteoid (O) and loose fibrovascular tissue of the aneurysmal bone cyst is seen on both sides of the arterial branch. Sectioning artifact (SA) is also seen. (Block 28, C2 vertebra, level 352, Movat’s pentachrome stain, x20 original magnification.)