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Imaging Case Book

Cerebral arteriovenous fistula to pulmonary artery onyx embolization

Journal of Perinatology volume 27, pages 238–240 (2007)Cite this article

The most common cerebral venous aneurysm with arteriovenous fistula is a Vein of Galen Aneurysm. The mortality of patients untreated is 90%.1 Nongalenic arteriovenous malformations with venous aneurysm or varix are less common. They present in a similar manner, 54% with congestive heart failure, 31% with seizures and 15% with cerebral hemorrhage. Because of the high mortality endovascular therapy is the treatment of choice for galenic and nongalenic lesions.2, 3 Nevertheless therapy is not without complications; only 12.5% of infants improved clinically after therapy.2

Onyx is a liquid embolic material now used in the endovascular treatment of cerebral and peripheral arteriovenous malformations and cerebral aneurysms.4, 5 It is an ethylene vinyl alcohol copolymer dissolved in an organic solvent, dimethyl sulfoxide (DMSO). Onyx slowly solidifies on contact with blood as the DMSO is dispersed. This neonate developed worsening congestive heart failure owing to the large congenital right deep parietooccipital venous aneurysm and arteriovenous fistula, similar to a vein of Galen aneurysm. Endovascular therapy was undertaken with embolization of coils and Onyx. Our case demonstrates that Onyx material may cause embolus of the pulmonary artery after its use. The child's death was not related to pulmonary hypertension and congestive heart failure, but to intracranial hemorrhage, which is probably more common in children with arteriovenous malformations than in adults.6

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Authors and Affiliations

  1. Department of Radiology, Mallinckrodt Institute of Radiology, St Louis Children's Hospital, Washington University, St Louis, MO, USA

    T E Herman, M J Siegel & P Masand

  2. Division of Neonatology, Department of Pediatrics, St Louis Children's Hospital, Children's Place, Washington University School of Medicine, St Louis, MO, USA

    A Vachharajani

  3. Division Interventional Neuroradiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO, USA

    D Cross

Authors
  1. T E Herman
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  2. M J Siegel
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  3. A Vachharajani
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  4. P Masand
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  5. D Cross
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Correspondence to T E Herman.

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Herman, T., Siegel, M., Vachharajani, A. et al. Cerebral arteriovenous fistula to pulmonary artery onyx embolization. J Perinatol 27, 238–240 (2007). https://doi.org/10.1038/sj.jp.7211680

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  • DOI: https://doi.org/10.1038/sj.jp.7211680

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