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Gefässchirurgie

, Volume 23, Issue 7, pp 507–512 | Cite as

Histopathologic analysis of craniofacial arteriovenous malformations following Onyx embolization

A single center retrospective review
  • M. HossEmail author
  • B. Hollowoa
  • C.-Y. Fan
  • B. Fogel
  • M. Meek
Leitthema
  • 61 Downloads

Abstract

Ethylene-vinyl alcohol copolymer (Onyx) has been proposed as a suitable alternative embolic agent in the management of craniofacial arteriovenous malformations (CFAVM). Short-term efficacy studies have demonstrated promising results with good nidus penetration on post-treatment angiography. This article reports the histopathologic findings of direct vascular recanalization with Onyx at the time of surgical resection. A retrospective review of eight patients who underwent Onyx embolization followed by surgical excision for CFAVM was performed. The surgical specimens were evaluated for the presence of recanalized blood vessels in the embolic cast material and inflammatory changes. A total of 8 patients (mean age 31 years, range 15–57 years) underwent 25 CFAVM embolization and 16 surgical specimens were taken. The time period between initial Onyx embolization and surgery ranged from 12 months to 108 months. Onyx was identified in all of the 16 specimens at the time of resection. Recanalization was identified in 12 of the 16 specimens (75%). Chronic inflammatory changes were present in 13 of the 16 specimens (81.25%) ranging from mild (8) and moderate (4) to severe (1). Giant cells were present in 15 of the 16 specimens (93.75%). Staged Onyx embolization has been reported as clinically efficacious in the management of CFAVM with permanent occlusive properties. Recanalization was commonly seen in this patient cohort as early as 12 months after initial endovascular treatment. Further studies are needed to confirm these findings to evaluate the permanence of Onyx as single agent management for CFAVM.

Keywords

Endovascular technique Inflammation Embolization Recanalization Giant cells 

Histopathologische Analyse kraniofaszialer arteriovenöser Malformationen nach Onyx-Embolisation

Ein retrospektives Singlecenter-Review

Zusammenfassung

Ethylen-Vinylalkohol-Copolymer (Onyx) wurde als geeigneter alternativer Wirkstoff für die Embolisation zur Behandlung kraniofaszialer arteriovenöser Malformationen (CFAVM) eingeführt. Kurzzeitstudien zur Wirksamkeit haben vielversprechende Ergebnisse mit guter Niduspenetration in der Angiographie nach der Behandlung gezeigt. Dieser Beitrag berichtet über die histopathologischen Befunde der direkten vaskulären Rekanalisation mit Onyx zum Zeitpunkt der chirurgischen Resektion. Ein retrospektives Review von 8 Patienten, die sich einer Embolisation mit Onyx gefolgt von einer chirurgischen Exzision aufgrund CFAVM unterzogen, wurde durchgeführt. Die während der Operation entnommenen Proben wurden auf das Vorliegen rekanalisierter Blutgefäße im embolischen Cast-Material und entzündliche Veränderungen untersucht. Insgesamt 8 Patienten (mittleres Alter: 31 Jahre, Range: 15–57 Jahre) unterzogen sich 25 CFAVM-Embolisationen, und 16 chirurgische Proben wurden entnommen. Der Zeitraum zwischen der ersten Onyx-Embolisation und der Operation lag zwischen 12 und 108 Monaten. In allen 16 Proben wurde Onyx zum Zeitpunkt der Resektion identifiziert. Eine Rekanalisation wurde in 12 von 16 Proben (75 %) festgestellt. Chronische entzündliche Veränderungen lagen in 13 von 16 Proben (81,25 %) vor und reichten von mild (8) und moderat (4) bis hin zu schwer (1). Riesenzellen lagen in 15 von 16 Proben vor (93,75 %) vor. Die stufenweise Onyx-Embolisation wurde als klinisch wirksam in der Behandlung von CFAVM mit permanenten okklusiven Eigenschaften angegeben. Eine Rekanalisation wurde in dieser Patientenkohorte häufig schon 12 Monate nach der ersten endovaskulären Behandlung festgestellt. Weitere Studien sind notwendig, um diese Ergebnisse zu bestätigen und die langfristige Wirkung von Onyx als Einzelwirkstoff zur Behandlung von CFAVM zu beurteilen.

Schlüsselwörter

Endovaskuläre Technik Entzündung Embolisation Rekanalisation Riesenzellen 

Notes

Compliance with ethical guidelines

Conflict of interest

M. Hoss, B. Hollowoa, C.-Y. Fan, B. Fogel and M. Meek declare that they have no competing interests.

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1975 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

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Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2018

Authors and Affiliations

  • M. Hoss
    • 1
    Email author
  • B. Hollowoa
    • 1
  • C.-Y. Fan
    • 2
  • B. Fogel
    • 2
  • M. Meek
    • 1
  1. 1.Department of RadiologyUniversity of Arkansas for Medical SciencesLittle RockUSA
  2. 2.Department of PathologyUniversity of Arkansas for Medical SciencesLittle RockUSA

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