J Cerebrovasc Endovasc Neurosurg.  2017 Sep;19(3):189-195. 10.7461/jcen.2017.19.3.189.

Cranial Nerve Palsy after Onyx Embolization as a Treatment for Cerebral Vascular Malformation

• Lee JM
• Whang K
• Cho SM
• Kim JY
• Oh JW
• Koo YM
• Hu C
• Pyen J
• Choi JW

• KMID: 2393501
• DOI: http://doi.org/10.7461/jcen.2017.19.3.189

Abstract

The Onyx liquid embolic system is a relatively safe and commonly used treatment for vascular malformations, such as arteriovenous fistulas and arteriovenous malformations. However, studies on possible complications after Onyx embolization in patients with vascular malformations are limited, and the occurrence of cranial nerve palsy is occasionally reported. Here we report the progress of two different types of cranial nerve palsy that can occur after embolization. In both cases, Onyx embolization was performed to treat vascular malformations and ipsilateral oculomotor and facial nerve palsies were observed. Both patients were treated with steroids and exhibited symptom improvement after several months. The most common types of neuropathy that can occur after Onyx embolization are facial nerve palsy and trigeminal neuralgia. Although the mechanisms underlying these neuropathies are not clear, they may involve traction injuries sustained while extracting the microcatheter, mass effects resulting from thrombi and edema, or Onyx reflux into the vasa nervorum. In most cases, the neuropathy spontaneously resolves several months following the procedure.

Keyword

Arteriovenous fistula; Onyx embolization; Cranial nerve palsy

MeSH Terms

Arteriovenous Fistula
Arteriovenous Malformations
Cranial Nerve Diseases*
Cranial Nerves*
Edema
Facial Nerve
Humans
Paralysis
Steroids
Traction
Trigeminal Neuralgia
Vasa Nervorum
Vascular Malformations*
Steroids

Figure

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  Fig. 1 Endovascular embolization by Onyx. (A, B) Preoperative left external carotid artery images (antero-posterior view, lateral view); (C, D) postoperative left external carotid artery images (antero-posterior view, lateral view). After Onyx embolization, carotid-cavernous fistula flow through the right external carotid artery disappears.

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  Fig. 2 Postoperative right oculomotor nerve function test. (A) Frontal gaze; (B) lateral gaze; (C) medial gaze; (D) ptosis in the neutral position.

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  Fig. 3 Endovascular embolization by Onyx. (A, B) Preoperative right external carotid artery images (antero-posterior view, lateral view); (C, D) postoperative right external carotid artery images (antero-posterior view, lateral view). After Onyx embolization, arteriovenous fistula flow through the left external carotid artery disappears.

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  Fig. 4 Postoperative facial nerve examination with right facial nerve palsy (House-Brackmann GV). (A) At rest. (B) Closing eyes. (C) Smiling. (D) Open mouth.

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