Resection of a posterior fossa arteriovenous malformation complicated by leaked Onyx: a case report and review of literature.

Onyx extravasation is a rare complication during embolization of arteriovenous malformations (AVM). We present a case of embolization complicated by Onyx leak into the cerebellum later encountered during surgical excision of the AVM. Our goal is to report on these rare events and to outline the successful treatment of this complication.

patient records are reviewed for medical history, laboratory and radiological examinations, and outpatient follow-up clinics. A 62-year-old woman presented with a hunting Hess modified grade 2 and grade Fisher 2 subarachnoid hemorrhage (SAH) secondary to a ruptured left lower posterior cerebellar artery (PICA) aneurysm associated with vermian superior cerebellar AVM.

After endovascular intervention, totally embolized aneurysm; However, only 75% of the AVM can be safely eliminated. Onyx extravasation of aneurysm rupture was recorded on the first angiogram. Elective suboccipital craniectomy then planned for residual AVM resection where extravasated Onyx caused a disturbance during resection surgery. Post-op angiogram confirmed complete resection of the AVM, as well as most of the extravasated Onyx. Patients did well post-surgery, neurological residual intact during the course of the hospital.

Although rarely reported in the literature, Onyx extravasation is a potential complication that neurosurgeons have to be prepared to face. Compliance of Onyx into the surrounding parenchyma could inhibit optimal surgical resection of AVM and increased complications. Therefore, careful surgical dissection should be done with special care for delicate neurovasculature. In this case, a complete resection of the AVM and the mass of the Onyx safely reached.

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