Embolization of High-Flow Craniofacial Vascular Malformations with Onyx

Abstract

BACKGROUND AND PURPOSE:Various techniques and materials have been used for the endovascular treatment of craniofacial high-flow arteriovenous vascular malformations, because their rarity precludes standardization of their treatment. The aim of this retrospective review is to assess Onyx as the primary embolic agent in the treatment of these vascular malformations.

Preliminary experience with precipitating hydrophobic injectable liquid in brain arteriovenous malformations

“…PHIL has a white color, which may offer aesthetic advantage for use in vascular malformations in the face (11).…”

Interventional Neuroradiology of the Head and Neck

“…Angiographically, the craniofacial high-flow VMs may consist of a nidus (AVMs) or direct communications between arteries and veins (arteriovenus fistulas), 33 though the precise distinction between these 2 types may not always be possible. A variety of embolic agents have been used for the treatment of high-flow lesions, including ethanol, n-BCA, Onyx (Contour PVA particles; Boston Scientific, Natick, Mass), and coils.…”

“…A variety of embolic agents have been used for the treatment of high-flow lesions, including ethanol, n-BCA, Onyx (Contour PVA particles; Boston Scientific, Natick, Mass), and coils. 33,34 Transarterial endovascular embolization of high-flow lesions with particles is generally not effective because of frequently incomplete closure as well as recurrence of the AVM. Transarterial n-BCA is more effective and permanent, 35 but staged procedures may be necessary and distal microcatheter access may be difficult when there is excessive vascular tortuosity.…”

“…However, when an AVM has multiple venous drainage channels, a compression device for circumferential flow reduction can be more effective than manual digital compression. 37 Alternatively, a temporary balloon may be inflated in the feeding artery 33 to decrease the rate of shunt surgery and limit the backward reflux of embolic material in the feeding vessel. Direct-puncture embolization of an AVM is technically easier compared with transarterial embolization, reduces the procedure time, and has the advantage of reducing the risk of ischemic complications (skin necrosis and brain or retinal ischemia).…”

“…33,35,36 The nidus and/or the draining vein can be embolized with n-BCA or Onyx by using this approach (Fig 5). Flow-modifi- A 33-year-old man with a family history of multiple paragangliomas and a palpable left neck mass.…”