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Flow control using ScepterTM balloons for Onyx embolization of a vein of Galen aneurysmal malformation

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Abstract

Purpose

We present a technical development of the endovascular treatment technique for vein of Galen aneurysmal malformation, using Onyx™ (ethylene vinyl alcohol copolymer) delivered under flow control through double-lumen balloon microcatheters.

Materials and methods

An 11-month-old patient that initially presented with increasing head circumference was diagnosed with mural type vein of Galen aneurysmal malformation. Complete cure was obtained in a single endovascular treatment session. Onyx was delivered simultaneously through two double-lumen balloon microcatheters (Scepter™, Microvention, Terumo Group). In both arterial feeders, balloon inflation occluded the high-flow arterial-venous shunting and thus facilitated the controlled propagation of the embolic product in the afferent artery and the shunt point while preventing distal migration into the venous system.

Results

Two years post-procedure, MR imaging showed persistent occlusion of arterial-venous shunts with complete regression of the venous dilatation. On clinical examination, the patient had no neurological deficits, and no cognitive impairment was detected at neuropsychological testing.

Conclusion

The use of double-lumen balloon microcatheters for flow control during delivery of Onyx represents a viable alternative for the endovascular treatment of vein of Galen aneurysmal malformations.

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References

  1. Albuquerque FC, Ducruet AF, Crowley RW, Bristol RE, Ahmed A, McDougall CG (2014) Transvenous to arterial Onyx embolization. J Neurointerv Surg 6(4):281–285

    Article  PubMed  Google Scholar 

  2. Berenstein A, Fifi JT, Niimi Y, Presti S, Ortiz R, Ghatan S et al (2012) Vein of Galen malformations in neonates: new management paradigms for improving outcomes. Neurosurgery 70:1207–1214

    Article  PubMed  Google Scholar 

  3. Dabus G, Linfante I, Martínez-Galdámez M (2014) Endovascular treatment of dural arteriovenous fistulas using dual lumen balloon microcatheter: technical aspects and results. Clin Neurol Neurosurg 117:22–27

    Article  PubMed  Google Scholar 

  4. Gailloud P, O’Riordan DP, Burger I, Levrier O, Jallo G, Tamargo RJ et al (2005) Diagnosis and management of vein of Galen aneurysmal malformations. J Perinatol 25:542–551

    Article  PubMed  Google Scholar 

  5. Jagadeesan BD, Grigoryan M, Hassan AE, Grande AW, Tummala RP (2013) Endovascular balloon-assisted embolization of intracranial and cervical arteriovenous malformations using dual-lumen coaxial balloon microcatheters and onyx: initial experience. Neurosurgery 73(ONS Suppl 2):ons238–ons243

    Article  PubMed  Google Scholar 

  6. Jagadeesan BD, Mortazavi S, Hunter DW, Duran-Castro OL, Snyder GB, Siedel GF, Golzarian J (2014) Endovascular balloon-assisted embolization of high-flow peripheral vascular lesions using dual-lumen coaxial balloon microcatheter and onyx: initial experience. J Vasc Interv Radiol 25(4):587–592

    Article  PubMed  Google Scholar 

  7. Khullar D, Andeejani AMI, Bulsara KR (2010) Evolution of treatment options for vein of Galen malformations. J Neurosurg Pediatr 6:444–451

    Article  PubMed  Google Scholar 

  8. Kim ST, Jeong HW, Seo J (2013) Onyx embolization of dural arteriovenous fistula, using scepter C balloon catheter: a case report. Neurointervention 8(2):110–114

    Article  PubMed Central  PubMed  Google Scholar 

  9. Lasjaunias PL, Berenstein A, ter Brugge KG (2006) Surgical neuroangiography. 3rd volume—clinical and interventional aspects in children, 2nd edn. Springer, Berlin

    Book  Google Scholar 

  10. Lasjaunias PL, Chng SM, Sachet M, Alvarez H, Rodesch G, Garcia-Monaco R (2006) The management of vein of Galen aneurysmal malformations. Neurosurgery 59:S3184–S3194

    Article  Google Scholar 

  11. Li A, Armstrong D, ter Brugge KG (2011) Endovascular treatment of vein of Galen aneurysmal malformation: management strategy and 21-year experience in Toronto. J Neurosurg Pediatr 7:3–10

    Article  PubMed  Google Scholar 

  12. Martínez-Galdámez M, Rodriguez-Arias CA, Utiel E, Arreba E, Gonzalo M, Arenillas JF (2014) Paraspinal arteriovenous malformation Onyx embolization via an Ascent balloon. J Neurointerv Surg 6(3):e19

    Article  PubMed  Google Scholar 

  13. Paramasivam S, Niimi Y, Fifi J, Berenstein A (2013) Onyx embolization using dual-lumen balloon catheter: initial experience and technical note. J Neuroradiol 40(4):294–302

    Article  PubMed  Google Scholar 

  14. Pearl M, Gomez J, Gregg L, Gailloud P (2010) Endovascular management of vein of Galen aneurysmal malformations. Influence of the normal venous drainage on the choice of a treatment strategy. Childs Nerv Syst 26:1367–1379

    Article  PubMed  Google Scholar 

  15. Spiotta AM, Miranpuri AS, Vargas J, Magarick J, Turner RD, Turk AS et al (2013) Balloon augmented Onyx embolization utilizing a dual lumen balloon catheter: utility in the treatment of a variety of head and neck lesions. J Neurointerv Surg. doi:10.1136/neurintsurg-2013-010833

    Google Scholar 

  16. Thiex R, Williams A, Smith E, Scott RM, Orbach DB (2010) The use of Onyx for embolization of central nervous system arteriovenous lesions in pediatric patients. AJNR Am J Neuroradiol 31:112–120

    Article  CAS  PubMed  Google Scholar 

  17. Tsimpas A, Chalouhi N, Halevy JD, Tjoumakaris S, Gonzalez LF, Monteith SJ et al (2013) The use of adenosine in the treatment of a high-flow vein of Galen malformation in an adult. J Clin Neurosci. doi:10.1016/j.jocn.2013.11.014

    PubMed  Google Scholar 

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Conflict of interest

The authors declare that they have no conflicts of interest.

Human rights and informed consent

This article was written using retrospective data from anonymized patient files. No informed consent is needed.

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Authors and Affiliations

  1. Interventional Neuroradiology Department, Hôpitaux Universitaires de Strasbourg, Strasbourg, France

    Raoul Pop, Monica Manisor & Rémy Beaujeux

  2. Institut Hospitalo-Universitaire, Strasbourg, France

    Raoul Pop

  3. Neurosurgery Department, Hôpitaux Universitaires de Strasbourg, Strasbourg, France

    Pierre Kehrli

  4. Vascular Neurology Department, Hôpitaux Universitaires de Strasbourg, Strasbourg, France

    Valérie Wolff & Christian Marescaux

Authors
  1. Raoul Pop
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  2. Monica Manisor
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  3. Valérie Wolff
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  4. Pierre Kehrli
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  5. Christian Marescaux
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  6. Rémy Beaujeux
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Corresponding author

Correspondence to Raoul Pop.

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Pop, R., Manisor, M., Wolff, V. et al. Flow control using ScepterTM balloons for Onyx embolization of a vein of Galen aneurysmal malformation. Childs Nerv Syst 31, 135–140 (2015). https://doi.org/10.1007/s00381-014-2576-3

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  • DOI: https://doi.org/10.1007/s00381-014-2576-3

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