Incidental occlusion of anterior spinal artery due to Onyx reflux in embolization of spinal type II arteriovenous malformation

• Published in: European spine journal 2017-05, Vol.26 (Suppl 1), p.75-79
• Main Authors: Kim, Joohyun, Lee, Jang-Bo, Cho, Tai-Hyoung, Hur, Junseok W.
• Format: Article
• Language: English
• Subjects: Adolescent; Angiography; Arteriovenous Malformations - diagnostic imaging; Arteriovenous Malformations - therapy; Balloon catheters; Case Report; Central Nervous System Vascular Malformations - diagnostic imaging; Central Nervous System Vascular Malformations - therapy; Cerebral blood flow; Cranial nerves; Embolization; Embolization, Therapeutic - adverse effects; Humans; Ischemia; Magnetic Resonance Imaging; Male; Medicine; Medicine & Public Health; Neuroimaging; Neurosurgery; Postoperative Complications - diagnostic imaging; Postoperative Complications - etiology; Postoperative Complications - rehabilitation; Postoperative Period; Quadriplegia - etiology; Quadriplegia - rehabilitation; Rehabilitation; Skull; Spinal Cord - blood supply; Spinal Cord Ischemia - diagnostic imaging; Spinal Cord Ischemia - etiology; Spinal Cord Ischemia - rehabilitation; Spine; Surgical Orthopedics; Treatment Outcome; Veins & arteries; Vertebrae; Vertebral Artery
• ISSN: 0940-6719; 1432-0932
• DOI: 10.1007/s00586-016-4767-y

Purpose Onyx embolization is one of the standard treatments for brain arteriovenous malformations (AVMs) and is a promising method for spinal AVMs as well. Its advantages have been emphasized, and few complications have been reported with Onyx embolization in spinal AVMs. Here, we report an incidental anterior spinal artery (ASA) occlusion due to Onyx reflux during embolization of a spinal type II AVM. Methods A 15-year-old boy presented with weakness in both upper and lower extremities. Magnetic resonance imaging and spinal angiogram revealed a spinal type II AVM with two feeders including the right vertebral artery (VA) and the right deep cervical artery. Results Onyx embolization was performed gradually from the VA to the deep cervical artery and an unexpected Onyx reflux to the ASA was observed during the latter stage deep cervical artery embolization. Post-operative quadriplegia and low cranial nerves (CN) dysfunction were observed. Rehabilitation treatment was performed and the patient showed marked improvement of neurologic deterioration at 1-year follow-up. Conclusions Onyx is an effective treatment choice for spinal AVMs. However, due to the small vasculature of the spine compared to the brain, the nidus is rapidly packed with a small amount of Onyx, which allows Onyx reflux to unexpected vessels. Extreme caution is required and dual-lumen balloon catheter could be considered for Onyx embolization in spinal AVMs treatment.