A Case Report of Onyx Pulmonary Arterial Embolism Contributing to Hypoxemia During Awake Craniotomy for Arteriovenous Malformation Resection

A A Case Rep. 2017 Feb 15;8(4):86-88. doi: 10.1213/XAA.0000000000000436.

Abstract

A healthy 26-year-old man with cerebral arteriovenous malformation underwent staged endovascular embolization with Onyx followed by awake craniotomy for resection. The perioperative course was complicated by tachycardia and severe intraoperative hypoxemia requiring significant oxygen supplementation. Postoperative chest computed tomography (CT) revealed hyperattenuating Onyx embolization material within the pulmonary vasculature, and an electrocardiogram indicated possible right heart strain, supporting clinically significant embolism. With awake arteriovenous malformation resection following adjunctive Onyx embolization becoming increasingly employed for lesions involving the eloquent cortex, anesthesiologists need to be aware of pulmonary migration of Onyx material as a potential contributor to significant perioperative hypoxemia.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Computed Tomography Angiography
  • Craniotomy*
  • Dimethyl Sulfoxide / adverse effects*
  • Embolization, Therapeutic / adverse effects*
  • Endovascular Procedures
  • Humans
  • Hypoxia / etiology*
  • Intracranial Arteriovenous Malformations / therapy*
  • Intraoperative Complications / diagnostic imaging
  • Intraoperative Complications / etiology*
  • Male
  • Polyvinyls / adverse effects*
  • Pulmonary Artery / diagnostic imaging*
  • Pulmonary Embolism / diagnostic imaging
  • Pulmonary Embolism / etiology*
  • Tantalum / adverse effects*
  • Tomography, X-Ray Computed

Substances

  • Onyx 34
  • Polyvinyls
  • Tantalum
  • Dimethyl Sulfoxide