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Intracerebral hemorrhage following endovascular embolization of brain arteriovenous malformation with a combination of Onyx and n-butyl cyanoacrylate: a case report

Published:November 02, 2011DOI:https://doi.org/10.1016/j.clinimag.2011.09.003

      Abstract

      We report a 29-year-old female patient who developed intracerebral hemorrhage 16 h after endovascular embolization of a brain arteriovenous malformation with a combination of liquid embolic agents of Onyx and n-butyl cyanoacrylate. After emergent craniectomy with evacuation of the hematoma, the patient recovered consciousness with mild expressive aphasia. The possible etiology of postembolization brain hemorrhage was discussed, and the literature was reviewed.

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      References

        • Achrol AS
        • Guzman R
        • Varga M
        • Adler JR
        • Steinberg GK
        • Chang SD
        Pathogenesis and radiobiology of brain arteriovenous malformations: implications for risk stratification in natural history and posttreatment course.
        Neurosurg Focus. 2009; 26: E9
        • Da Costa L
        • Wallace MC
        • Ter Brugge KG
        • O'Kelly C
        • Willinsky RA
        • Tymianski M
        The natural history and predictive features of hemorrhage from brain arteriovenous malformations.
        Stroke. 2009; 40: 100-105
        • Henkes H
        • Gotwald TF
        • Brew S
        • Miloslavski E
        • Kämmerer
        • Kühne D
        Intravascular pressure measurements in feeding pedicles of brain arteriovenous malformations.
        Neuroradiology. 2006; 48: 182-189
        • Brown RD
        • Wiebers DO
        • Forbes G
        • O'Fallon WM
        • Piepgras DG
        • Marsh WR
        • Maciunas RJ
        The natural history of unruptured intracranial arteriovenous malformations.
        J Neurosurg. 1988; 68: 352-357
        • Crawford PM
        • West CR
        • Chadwick DW
        • Shaw MD
        Arteriovenous malformations of the brain: natural history in unoperated patients.
        J Neurol Neurosurg Psychiatry. 1986; 49: 1-10
        • Hartmann A
        • Mast H
        • Mohr JP
        • Koennecke H-C
        • Osipov A
        • Pile-Spellman J
        • Duong DH
        • Young WL
        Morbidity of intracranial hemorrhage in patients with cerebral arteriovenous malformation.
        Stroke. 1998; 29: 931-934
        • Hillman J
        Population-based analysis of arteriovenous malformation treatment.
        J Neurosurg. 2001; 95: 633-637
        • Ondra SL
        • Troupp H
        • George ED
        • Schwab K
        The natural history of symptomatic arteriovenous malformations of the brain: a 24-year follow-up assessment.
        J Neurosurg. 1990; 73: 387-391
        • The arteriovenous malformation study group
        Current concept: arteriovenous malformations of the brain in adults.
        N Engl J Med. 1999; 340: 1812-1818
        • Panagiotopoulos V
        • Gizewski E
        • Asgari S
        • Regel J
        • Forsting M
        • Wanke I
        Embolization of intracranial arteriovenous malformations with ethylene-vinyl alcohol copolymer (Onyx).
        AJNR Am J Neuroradiol. 2009; 30: 99-106
        • Heidenreich JO
        • Hartlieb S
        • Stendel R
        • Pietilä TA
        • Schlattmann P
        • Wolf K-J
        • Schilling AM
        Bleeding complications after endovascular therapy of cerebral arteriovenous malformations.
        AJNR Am J Neuroradiol. 2006; 27: 313-316
        • Picard L
        • Da Costa E
        • Anxionnat R
        • Macho J
        • Bracard S
        • Per A
        • Marchal JC
        Acute spontaneous hemorrhage after embolization of brain arteriovenous malformation with n-butyl cyanoacrylate.
        J Neuroradiol. 2001; 28: 147-165
        • Iwama T
        • Yoshimura K
        • Keller E
        • Imhof H-G
        • Khan N
        • Leblebicioglu-Könu D
        • Tanaka M
        • Valavanis A
        • Yonekawa Y
        Emergency craniotomy for intraparenchymal massive hematoma after embolization of supratentorial arteriovenous malformations.
        Neurosurgery. 2003; 53: 1251-1260
        • van Rooij WJ
        • Sluzewski M
        • Beute GN
        Brain AVM embolization with Onyx.
        AJNR Am J Neuroradiol. 2007; 28: 172-177
        • Spetzler RF
        • Wilson CB
        • Weinstein P
        • Mehdorn M
        • Townsend J
        • Telles D
        Normal perfusion pressure breakthrough theory.
        Clin Neurosurg. 1978; 25: 651-672
        • Charbel FT
        • Hoffman WE
        • Misra M
        • Ausman JI
        Increased brain tissue oxygenation during arteriovenous malformation resection.
        Neurol Med Chir (Tokyo). 1998; 38: 171-176
        • Hoffman WE
        • Charbel FT
        • Edelman G
        • Abood C
        Brain tissue response to CO2 in patients with arteriovenous malformation.
        J Cereb Blood Flow Metab. 1996; 16: 1383-1386
        • Meyer B
        • Schaller C
        • Frenkel C
        • Ebeling B
        • Schramm J
        Distributions of local oxygen saturation and its response to changes of mean arterial blood pressure in the cerebral cortex adjacent to arteriovenous malformations.
        Stroke. 1999; 30: 2623-2630
        • Young WL
        • Kader A
        • Ornstein E
        • Baker KZ
        • Ostapkovich N
        • Pile-Spellman J
        • Fogarty-Mack P
        • Stein BM
        Cerebral hyperemia after arteriovenous malformation resection is related to “breakthrough” complications but not to feeding artery pressure.
        Neurosurgery. 1996; 38: 1085-1093
        • Hartmann A
        • Mast H
        • Mohr JP
        • Pile-Spellman J
        • Connolly ES
        • Sciacca RR
        • Khaw A
        • Stapf C
        Determinants of staged endovascular and surgical treatment outcome of brain arteriovenous malformations.
        Stroke. 2005; 36: 2431-2435
        • Nishizawa S
        • Ryu H
        • Yokoyama T
        • Kitamura S
        • Uemura K
        Intentionally staged operation for large and high-flow cerebral arteriovenous malformation.
        J Clin Neurosci. 1998; 5: 78-85
        • Ogasawa K
        • Yoshida K
        • Otawara Y
        • Kobayashi M
        • Yasuda S
        • Doi M
        • et al.
        Cerebral blood flow imaging in arteriovenous malformation complicated by normal perfusion pressure breakthrough.
        Surg Neurol. 2001; 56: 380-384