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Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Onyx embolization of intracranial arteriovenous malformations in pediatric patients
Maryam Soltanolkotabi1, Samantha E Schoeneman, Tord D Alden
1Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA.
Insights
Onyx embolization is a feasible treatment for pediatric intracranial arteriovenous malformations (AVMs), with most complications being transient or silent. This approach offers a safe option for managing these complex pediatric vascular lesions.
Area of Science:
- Neurology
- Interventional Radiology
- Pediatric Neurosurgery
Background:
- Intracranial arteriovenous malformations (AVMs) pose significant risks in pediatric patients.
- Onyx embolization is an emerging endovascular technique for AVM treatment.
Purpose of the Study:
- To evaluate the safety and efficacy of Onyx embolization for pediatric intracranial AVMs.
- To assess complication rates and neurological outcomes associated with Onyx embolization in children.
Main Methods:
- Retrospective review of consecutive pediatric intracranial AVM cases treated with Onyx embolization over 5 years.
- Analysis of procedural details, AVM characteristics (Spetzler-Martin grade), and patient outcomes.
Main Results:
- 38 procedures in 25 pediatric patients (mean age 10.5 years) showed partial or complete AVM obliteration in all cases.
- 10 complications (26.3%) occurred, but none resulted in permanent neurological morbidity; deep venous drainage correlated with higher complication rates.
- 72% mean preoperative AVM devascularization was achieved in patients undergoing subsequent surgery.
Conclusions:
- Onyx embolization is a viable option for preoperative or primary treatment of pediatric intracranial AVMs.
- While complication rates were notable, they were predominantly transient or clinically silent, indicating a low risk of permanent morbidity.
- Careful attention to technical aspects and patient selection is crucial for optimizing safety and efficacy.
Object:
The authors undertook this study to assess the safety and efficacy of Onyx embolization in the treatment of intracranial arteriovenous malformations (AVMs) in pediatric patients.
Methods:
All pediatric Onyx embolization of intracranial AVM cases performed consecutively at a single children's hospital over a 5-year period were collected and evaluated.
Results:
Twenty-five patients (mean age 10.5 years) underwent a total of 38 procedures. An aggregate of 56 pedicles were embolized (mean 1.47 per session). The Spetzler-Martin grade was determined in all cases. Onyx embolization resulted in complete obliteration of the AVM in 3 cases (12%) and partial obliteration in 22 cases (88%). A total of 23 patients underwent surgical treatment. The mean preoperative AVM devascularization in these cases was 72%. One patient was treated with radiosurgery following Onyx embolization. Overall, 10 complications occurred in a total of 38 procedures (26.3%). None of the complications resulted in permanent neurological morbidity. The rate of transient neurological complications was 10.5% (4 of 38 procedures) and the rate of transient nonneurological complications was 5.3% (2 of 38 procedures). The remaining 4 complications were clinically silent (rate of 10.5%). There were no procedure-related deaths in this study population. There was no significant difference in patients with and without complications in terms of demographic characteristics, AVM grade, or embolization features (p ≥ 0.2). Deep venous drainage was associated with higher complication rates (p = 0.03).
Conclusions:
Onyx utilization is feasible for preoperative or primary embolization in the treatment of pediatric intracranial AVMs; however, the spectrum of complications encountered is broad, and attention must be paid to the technical nuances of and indications for its use to avoid many potential dangerous effects. Although the overall complication rates were higher than expected, all were either clinically silent or had only transient clinical effects. Thus, this experience suggests that Onyx embolization can be performed safely with a low rate of permanent morbidity in pediatric patients harboring these difficult lesions.
