|
Neurology India, Vol. 58, No. 5, September-October, 2010, pp. 817-818 Letter to Editor Successful embolization of a conus medullaris arteriovenous malformation using onyx SB Gaikwad, Sandeep Sharma, Subhash Kumar Department of Neuroradiology, All India Institute of Medical Sciences, New Delhi, India Correspondence Address: Date of Acceptance: 22-Jul-2010 Code Number: ni10237 PMID: 21045535 DOI: 10.4103/0028-3886.72207 Sir Conus medullaris vascular malformations occupy a special place in the classification of spinal vascular malformations, because of both the location and complex angio architecture. [1] Historically, spinal vascular malformations have been treated surgically and/or by endovascular embolization with glue with an ever increasing trial of the new embolic agent Onyx, which is endowed with many desirable properties. An 18-year-old male presented with history of pain and weakness in both the lower limbs of one year duration and bladder and bowel disturbances of nine months duration. On examination, he had mixed upper and lower motor neuron signs with power of 2/5 in both the lower limbs. MR imaging revealed T2W hyperintensity in the lower cord with multiple vascular flow voids. Spinal digital subtraction angiography revealed conus arterio-venous malformation (AVM) with supply mainly from the anterior spinal axis contributed by the right ninth dorsal (RD9) radiculomedullary artery and minor supply from the posterior spinal artery contributed by right eleventh dorsal (RD11) and right first lumbar (RL1) levels [Figure - 1]. Endovascular embolization was performed via the RD9 contributor after super selective catheterization with Ultraflow micro-catheter and injecting 0.5 mL of Onyx 18 into the most distal aspect of the feeder just proximal to the first fistula with good penetration of the Onyx into the complex AVM and also filling the draining veins up to some distance achieving complete AVM obliteration with preservation of normal vessels [Figure - 2]. MRI done on second day post-procedure showed complete resolution of the dilated flow voids, and T2 hyperintense signal had decreased. On day 1 post-procedure, the patient reported good subjective recovery and demonstrated mild objective improvement also. Conus AVMs have been recently segregated into a separate class of spinal vascular malformations, and treatment can be surgical or endovascular, as they can have multiple fistulous as well as true AVM nidus components. [1] Onyx is a new non-adherent liquid embolic agent, which gives more control over the injection and can backfill multiple feeding arteries from a single arterial injection and allows for casting of complex malformations. [2] Its role in the embolization of cerebral AVMs is now considered established. [3] Few authors have reported the use of Onyx in the embolization of spinal vascular malformations [Table - 1], mostly as case reports [4],[5],[6],[7] and a recent series of 17 patients by Corkill et al. Corkill et al . could achieve 82% rate of overall good clinical outcome. This is a case report of a successful embolization of conus AVM using Onyx, describing its feasibility in such lesions and also the relative simplicity of the procedure as compared to the complex nature of the conus AVM. References
Copyright 2010 - Neurology India The following images related to this document are available:Photo images[ni10237t1.jpg] [ni10237f1.jpg] [ni10237f2.jpg] |
|