P.121 Open surgical trans-venous Onyx embolization of Rolandic arteriovenous malformations: case report and review of literature. (17th June 2016)

• Record Type: Journal Article
• Authors: Wang, BH; Pelz, D; Pandey, S; Boulton, MR; Lownie, SP
• Is Part Of: Canadian journal of neurological sciences. Volume 43(2016)Supplement 2
• Page Start: S48
• Page End: S48
• Publication Date: 2016-06-17
• Subjects: Neurology -- Periodicals; Nervous system -- Surgery -- Periodicals; Electronic journals; 616.8
• DOI: 10.1017/cjn.2016.220
• Languages: English
• ISSNs: 0317-1671

Abstract

Abstract : Background: Premature occlusion of draining veins during surgical resection of arteriovenous malformations (AVM's) can lead to disastrous consequences. Interestingly, some authors have recently demonstrated effective endovascular trans-venous Onyx embolization of select AVM's.Methods: Case reportResults: A 71-year old female presented to the hospital with sudden onset right sided weakness and sensory change. Investigations revealed right fronto-parietal ICH secondary to a parasagittal Rolandic AVM with arterial supply from ACA and MCA branches. Drainage occurs via a single large cortical vein to the superior sagittal sinus. Partial intra-arterial embolization was initially performed. Surgical resection of the remaining nidus was deemed high risk. A craniotomy was performed and the large cortical draining vein was cannulated with a 4Fr micro-puncture system under direct visualization. A DMSO compatible micro-catheter was navigated retrograde close to the nidus. The draining vein was occluded using a surgical clip, and Onyx was immediately injected. Retrograde complete embolization of the AVM was observed. A total of 3ml of Onyx was injected, and the catheter was left in-situ. Patient was discharge 2 weeks later with minimal deficits.Conclusions: Open trans-venous embolization is a viable option for select AVM's with a single draining vein and are not favorable candidates for trans-arterial embolization, surgery or radiation.