Safety and efficacy of onyx embolization for pediatric cranial and spinal vascular lesions and tumors

Ramsey Ashour, Mohammad Ali Aziz-Sultan, Maryam Soltanolkotabi, Samantha E. Schoeneman, Tord D. Alden, Michael C. Hurley, Arthur J. Dipatri, Tadanori Tomita, Mohamed Elhammady, Ali Shaibani

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

BACKGROUND: Although Onyx is widely used to embolize vascular lesions in adults, the safety and efficacy of this liquid embolic agent for use in children are not well studied. OBJECTIVE: To report our experience using Onyx in pediatric patients for a variety of cranial and spinal vascular lesions and tumors to determine its procedural complication rates, types, and clinical consequences and to highlight the indications for and principles of Onyx embolization in pediatric patients. METHODS: All pediatric Onyx embolization cases performed consecutively by the neuroendovascular services at our 2 institutions over a 5-year period were collected retrospectively and analyzed. RESULTS: Over the study period, 105 Onyx embolization procedures were performed in 69 pediatric patients with a mean follow-up of 112 days. Fifty-two patients harbored "primary" vascular lesions (malformations, fistulas, etc), whereas 17 patients had tumors. Complications occurred in 25 of 105 procedures (23.8%) and included ischemic infarct (7), asymptomatic nontarget embolization (4), intracerebral hemorrhage (3), microcatheter-related vessel perforation (3), retained microcatheter (2), cerebral edema (2), dimethyl sulfoxide-induced pulmonary edema (2), facial ischemia (1), and contrast-induced bronchospasm (1). Neurological morbidity occurred transiently after 10 procedures (9.5%) and permanently after 2 procedures (1.9%). There were no procedure-related deaths. Statistical analysis revealed no predictors of complications among the multiple potential risk factors evaluated. CONCLUSION: Our experience suggests that Onyx can be used effectively for embolization of pediatric cranial and spinal vascular lesions and tumors with low permanent morbidity; however, attention must be paid to the technical nuances of and indications for its use to avoid potential complications.

Original languageEnglish
Pages (from-to)773-784
Number of pages12
JournalNeurosurgery
Volume71
Issue number4
DOIs
StatePublished - Oct 1 2012

Fingerprint

Blood Vessels
Pediatrics
Safety
Neoplasms
Morbidity
Bronchial Spasm
Vascular Malformations
Brain Edema
Cerebral Hemorrhage
Pulmonary Edema
Dimethyl Sulfoxide
Fistula
Ischemia

Keywords

  • Arteriovenous fistula
  • Arteriovenous malformation
  • Endovascular treatment
  • Onyx
  • Pediatrics
  • Spinal vascular malformation
  • Vein of Galen malformation

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Ashour, R., Aziz-Sultan, M. A., Soltanolkotabi, M., Schoeneman, S. E., Alden, T. D., Hurley, M. C., ... Shaibani, A. (2012). Safety and efficacy of onyx embolization for pediatric cranial and spinal vascular lesions and tumors. Neurosurgery, 71(4), 773-784. https://doi.org/10.1227/NEU.0b013e3182648db6

Safety and efficacy of onyx embolization for pediatric cranial and spinal vascular lesions and tumors. / Ashour, Ramsey; Aziz-Sultan, Mohammad Ali; Soltanolkotabi, Maryam; Schoeneman, Samantha E.; Alden, Tord D.; Hurley, Michael C.; Dipatri, Arthur J.; Tomita, Tadanori; Elhammady, Mohamed; Shaibani, Ali.

In: Neurosurgery, Vol. 71, No. 4, 01.10.2012, p. 773-784.

Research output: Contribution to journalArticle

Ashour, R, Aziz-Sultan, MA, Soltanolkotabi, M, Schoeneman, SE, Alden, TD, Hurley, MC, Dipatri, AJ, Tomita, T, Elhammady, M & Shaibani, A 2012, 'Safety and efficacy of onyx embolization for pediatric cranial and spinal vascular lesions and tumors', Neurosurgery, vol. 71, no. 4, pp. 773-784. https://doi.org/10.1227/NEU.0b013e3182648db6
Ashour R, Aziz-Sultan MA, Soltanolkotabi M, Schoeneman SE, Alden TD, Hurley MC et al. Safety and efficacy of onyx embolization for pediatric cranial and spinal vascular lesions and tumors. Neurosurgery. 2012 Oct 1;71(4):773-784. https://doi.org/10.1227/NEU.0b013e3182648db6
Ashour, Ramsey ; Aziz-Sultan, Mohammad Ali ; Soltanolkotabi, Maryam ; Schoeneman, Samantha E. ; Alden, Tord D. ; Hurley, Michael C. ; Dipatri, Arthur J. ; Tomita, Tadanori ; Elhammady, Mohamed ; Shaibani, Ali. / Safety and efficacy of onyx embolization for pediatric cranial and spinal vascular lesions and tumors. In: Neurosurgery. 2012 ; Vol. 71, No. 4. pp. 773-784.
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abstract = "BACKGROUND: Although Onyx is widely used to embolize vascular lesions in adults, the safety and efficacy of this liquid embolic agent for use in children are not well studied. OBJECTIVE: To report our experience using Onyx in pediatric patients for a variety of cranial and spinal vascular lesions and tumors to determine its procedural complication rates, types, and clinical consequences and to highlight the indications for and principles of Onyx embolization in pediatric patients. METHODS: All pediatric Onyx embolization cases performed consecutively by the neuroendovascular services at our 2 institutions over a 5-year period were collected retrospectively and analyzed. RESULTS: Over the study period, 105 Onyx embolization procedures were performed in 69 pediatric patients with a mean follow-up of 112 days. Fifty-two patients harbored {"}primary{"} vascular lesions (malformations, fistulas, etc), whereas 17 patients had tumors. Complications occurred in 25 of 105 procedures (23.8{\%}) and included ischemic infarct (7), asymptomatic nontarget embolization (4), intracerebral hemorrhage (3), microcatheter-related vessel perforation (3), retained microcatheter (2), cerebral edema (2), dimethyl sulfoxide-induced pulmonary edema (2), facial ischemia (1), and contrast-induced bronchospasm (1). Neurological morbidity occurred transiently after 10 procedures (9.5{\%}) and permanently after 2 procedures (1.9{\%}). There were no procedure-related deaths. Statistical analysis revealed no predictors of complications among the multiple potential risk factors evaluated. CONCLUSION: Our experience suggests that Onyx can be used effectively for embolization of pediatric cranial and spinal vascular lesions and tumors with low permanent morbidity; however, attention must be paid to the technical nuances of and indications for its use to avoid potential complications.",
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AU - Schoeneman, Samantha E.

AU - Alden, Tord D.

AU - Hurley, Michael C.

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