P.121 Open surgical trans-venous Onyx embolization of Rolandic arteriovenous malformations: case report and review of literature

Abstract

Background: Premature occlusion of draining veins during surgical resection of arteriovenous malformations (AVM’s) can lead to disastrous consequences. Interestingly, some authors have recently demonstrated effective endovascular trans-venous Onyx embolization of select AVM’s. Methods: Case report Results: A 71-year old female presented to the hospital with sudden onset right sided weakness and sensory change. Investigations revealed right fronto-parietal ICH secondary to a parasagittal Rolandic AVM with arterial supply from ACA and MCA branches. Drainage occurs via a single large cortical vein to the superior sagittal sinus. Partial intra-arterial embolization was initially performed. Surgical resection of the remaining nidus was deemed high risk. A craniotomy was performed and the large cortical draining vein was cannulated with a 4Fr micro-puncture system under direct visualization. A DMSO compatible micro-catheter was navigated retrograde close to the nidus. The draining vein was occluded using a surgical clip, and Onyx was immediately injected. Retrograde complete embolization of the AVM was observed. A total of 3ml of Onyx was injected, and the catheter was left in-situ. Patient was discharge 2 weeks later with minimal deficits. Conclusions: Open trans-venous embolization is a viable option for select AVM’s with a single draining vein and are not favorable candidates for trans-arterial embolization, surgery or radiation.