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First Line Onyx Embolization in Ruptured Pediatric Arteriovenous Malformations

Safety and Efficacy

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Abstract

Purpose

Brain arteriovenous malformations (bAVM) are the main cause of pediatric intracerebral hemorrhage (pICH). Embolization with Onyx (ev3, Irvine, CA, USA) in children with ruptured bAVM has been infrequently reported. The aim of this study was to assess the safety and efficacy profile of Onyx embolization as first line endovascular treatment of ruptured pediatric bAVMs.

Methods

Children with non-traumatic pICH due to bAVM rupture at a pediatric quaternary care center were prospectively enrolled in a registry and retrospectively analyzed between 2013 and 2018. Clinical and demographic data, treatment modalities and clinical imaging follow-up were retrieved, and detailed procedural data were retrospectively assessed by two investigators. The safety (procedural morbidity and mortality) and efficacy (obliteration and interval rebleeding) were evaluated.

Results

In this study 29 children treated for a bAVM by Onyx embolization were included (14 girls, 48%; median age 11.1 years, interquartile range, IQR 8.1–12.7 years) with a total of 72 endovascular sessions (median of 2 sessions per patient IQR 1–3). The AVMs were deeply located in 23 patients (79%). No systemic complications occurred, and no child experienced embolization-related persistent neurological deficits. Non-clinically relevant complications were observed during five procedures, unrelated to Onyx. After a mean follow-up of 31 months from rupture complete obliteration rates were 100%, 89%, 29%, 14% in bAVM Spetzler Martin grades I, II, III and IV–V, respectively.

Conclusion

It was found that Onyx embolization is safe and represents a good option for an initial treatment approach, in a sequential treatment strategy for pediatric ruptured brain AVMs. Younger age may not be an argument to deny Onyx embolization.

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Acknowledgements

We wish to thank the institution Imagine for its support, notably Dr. N. Garcelon for help with Dr Warehouse Software.

Funding

This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors

Author information

Authors and Affiliations

  1. Pediatric Radiology, Necker Children Hospital, Paris, France

    Quentin Alias, Grégoire Boulouis, Florent Gariel, Lorenzo Garzelli, Nathalie Boddaert, Francis Brunelle & Olivier Naggara

  2. INSERM UMR 1266 IMA-BRAIN, Department of Neuroradiology, CHSA, Université de Paris, Paris, France

    Grégoire Boulouis, Florent Gariel & Olivier Naggara

  3. Pediatric Neurosurgery Department, Necker Children Hospital, APHP, Paris, France

    Thomas Blauwblomme, Sandro Benichi, Kevin Beccaria & Florent Gariel

  4. Institut Imagine, INSERM UMR 1163, Université De Paris, Paris, France

    Thomas Blauwblomme, Sandro Benichi, Kevin Beccaria & Florent Gariel

  5. Department of Neuroradiology, University Hospital of Bordeaux, Bordeaux, France

    Florent Gariel

  6. Pediatric Neuro ICU, Necker Children Hospital, APHP, Paris, France

    Philippe Meyer

  7. Department of Pediatric Neurology, French Centre for Pediatric Stroke, APHP University Necker Children Hospital, Paris, France

    Manoelle Kossorotoff

Authors
  1. Quentin Alias
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  2. Grégoire Boulouis
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  3. Thomas Blauwblomme
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  4. Sandro Benichi
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  5. Kevin Beccaria
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  6. Florent Gariel
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  7. Lorenzo Garzelli
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  8. Philippe Meyer
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  9. Manoelle Kossorotoff
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  10. Nathalie Boddaert
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  11. Francis Brunelle
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  12. Olivier Naggara
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Contributions

All authors drafted and approved the final manuscript. Agreement to be accountable for all aspects of the work.

Corresponding author

Correspondence to Olivier Naggara.

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Conflict of interest

Q. Alias, G. Boulouis, T. Blauwblomme, S. Benichi, K. Beccaria, F. Gariel, L. Garzelli, P. Meyer, M. Kossorotoff, N. Boddaert, F. Brunelle and O.N. Naggara declare that they have no competing interests.

Additional information

Data Sharing

Any additional unpublished data are available, as anonymized grouped data, on request by a qualified investigator from the corresponding author.

Q. Alias and G. Boulouis: Equal participation as first authors.

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Alias, Q., Boulouis, G., Blauwblomme, T. et al. First Line Onyx Embolization in Ruptured Pediatric Arteriovenous Malformations. Clin Neuroradiol 31, 155–163 (2021). https://doi.org/10.1007/s00062-019-00861-6

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  • DOI: https://doi.org/10.1007/s00062-019-00861-6

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