J Cerebrovasc Endovasc Neurosurg.  2020 Dec;22(4):267-272. 10.7461/jcen.2020.E2019.09.006.

Foreign body granuloma reaction after endovascular therapy of an unruptured right frontal arteriovenous malformation

• Lopez-Calle J
• Colasanti R
• Chian C
• Choque-Velasquez J

• KMID: 2511040
• DOI: http://doi.org/10.7461/jcen.2020.E2019.09.006

Abstract

Foreign body reactions after endovascular procedures for brain arteriovenous malformations are extremely rare. We report the case of a cerebral foreign body granuloma reaction after embolization of a frontal arteriovenous malformation with Onyx. A previously treated 36-year-old man underwent re-embolization of a residual and recurrent unruptured right frontal vascular malformation with Onyx. The post-procedural imaging revealed a right frontotemporal heterogeneously enhancing expansive lesion associated with a residual malformation. Following microsurgical resection, the histopathological examination of the expansive lesion revealed basophilic foreign body like deposits adjacent to multi-nucleated giant cells, highly compatible with cerebral foreign body granulomas reaction to Onyx. The clinical and radiological follow-up of the patient was favorable after complete resection of the lesions.

Keyword

Brain arteriovenous malformation; Embolization; Endovascular therapy; Foreign body granuloma; Onyx

Figure

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  Fig. 1. (A) Cerebral angiography of a right frontal AVM (4×3 cm) fed by multiples frontal branches of the right middle cerebral artery. (B) Post-embolization cerebral angiography after initial treatment. (C) and (D) Last pre-operative cerebral angiography after the last embolization where a single draining vein to the superior sagittal sinus is observed. AVM, arteriovenous malformation.

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  Fig. 2. Cerebral T1WI MRI sequences after contrast administration (A) and T2WI MRI sequences (B) revealing a right frontotemporal heterogeneously enhancing expansive lesion with perilesional edema and a residual AVM. MRI, magnetic resonance imaging; AVM, arteriovenous malformation.

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  Fig. 3. Photomicrograph of the surgical specimen showing a foreign body granuloma with basophilic Onyx-like deposits associated with multinucleated giant cells (arrows).

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  Fig. 4. Postoperative cerebral angiography (A) and follow-up MRI (B) confirming the gross total resection of the fronto-temporal granulomatous lesion, as well as of the residual right frontal AVM. MRI, magnetic resonance imaging; AVM, arteriovenous malformation.

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