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Case Reports
. 2017 Sep;19(3):189-195.
doi: 10.7461/jcen.2017.19.3.189. Epub 2017 Sep 30.

Cranial Nerve Palsy after Onyx Embolization as a Treatment for Cerebral Vascular Malformation

Jong Min Lee  1 , Kum Whang  1 , Sung Min Cho  1 , Jong Yeon Kim  1 , Ji Woong Oh  1 , Youn Moo Koo  1 , Chul Hu  1 , Jinsoo Pyen  1 , Jong Wook Choi  1
Affiliations
Case Reports

Cranial Nerve Palsy after Onyx Embolization as a Treatment for Cerebral Vascular Malformation

Jong Min Lee et al. J Cerebrovasc Endovasc Neurosurg. 2017 Sep.

Abstract

The Onyx liquid embolic system is a relatively safe and commonly used treatment for vascular malformations, such as arteriovenous fistulas and arteriovenous malformations. However, studies on possible complications after Onyx embolization in patients with vascular malformations are limited, and the occurrence of cranial nerve palsy is occasionally reported. Here we report the progress of two different types of cranial nerve palsy that can occur after embolization. In both cases, Onyx embolization was performed to treat vascular malformations and ipsilateral oculomotor and facial nerve palsies were observed. Both patients were treated with steroids and exhibited symptom improvement after several months. The most common types of neuropathy that can occur after Onyx embolization are facial nerve palsy and trigeminal neuralgia. Although the mechanisms underlying these neuropathies are not clear, they may involve traction injuries sustained while extracting the microcatheter, mass effects resulting from thrombi and edema, or Onyx reflux into the vasa nervorum. In most cases, the neuropathy spontaneously resolves several months following the procedure.

Keywords: Arteriovenous fistula; Cranial nerve palsy; Onyx embolization.

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Conflict of interest statement

Disclosure: The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

Figures

Fig. 1
Fig. 1. Endovascular embolization by Onyx. (A, B) Preoperative left external carotid artery images (antero-posterior view, lateral view); (C, D) postoperative left external carotid artery images (antero-posterior view, lateral view). After Onyx embolization, carotid-cavernous fistula flow through the right external carotid artery disappears.
Fig. 2
Fig. 2. Postoperative right oculomotor nerve function test. (A) Frontal gaze; (B) lateral gaze; (C) medial gaze; (D) ptosis in the neutral position.
Fig. 3
Fig. 3. Endovascular embolization by Onyx. (A, B) Preoperative right external carotid artery images (antero-posterior view, lateral view); (C, D) postoperative right external carotid artery images (antero-posterior view, lateral view). After Onyx embolization, arteriovenous fistula flow through the left external carotid artery disappears.
Fig. 4
Fig. 4. Postoperative facial nerve examination with right facial nerve palsy (House-Brackmann GV). (A) At rest. (B) Closing eyes. (C) Smiling. (D) Open mouth.
See this image and copyright information in PMC

References

    1. Abud TG, Nguyen A, Saint-Maurice JP, Abud DG, Bresson D, Chiumarulo L, et al. The use of Onyx in different types of intracranial dural arteriovenous fistula. AJNR Am J Neuroradiol. 2011 Dec;32(11):2185–2191. - PMC - PubMed
    1. American Society of Interventional and Therapeutic Neuroradiology. Arteriovenous fistulae of the CNS. AJNR Am J Neuroradiol. 2001 Sep;22(8 Suppl):S22–S25. - PMC - PubMed
    1. Arat A, Inci S. Treatment of a superior sagittal sinus dural arteriovenous fistula with Onyx: technical case report. Neurosurgery. 2006 Jul;59(1 Suppl 1):ONSE169–ONSE170. discussion ONSE 169-70. - PubMed
    1. Chen J, Crane B, Niparko J, Gandhi D. Direct intraoperative confirmation of penetration of ethylene vinyl alcohol copolymer (Onyx) into the vasa nervosa of the facial nerve. J Neurointerv Surg. 2012 Nov;4(6):435–437. - PubMed
    1. Elhammady MS, Peterson EC, Aziz-Sultan MA. Onyx embolization of a carotid cavernous fistula via direct transorbital puncture. J Neurosurg. 2011 Jan;114(1):129–132. - PubMed

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