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Ch'ng LS, Zaki Z, Sobri Muda A. Embolization of brain arteriovenous malformations with squid co-polymer embolic material: Initial experience. J Interv Med 2023; 6:176-179. [PMID: 38312133 PMCID: PMC10831375 DOI: 10.1016/j.jimed.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 09/27/2023] [Accepted: 09/27/2023] [Indexed: 02/06/2024] Open
Abstract
Objective To analyze the safety and effectiveness of the ethylene-vinyl alcohol copolymer (EVOH) liquid embolic agent Squid (Emboflu, Switzerland) for the treatment of brain arteriovenous malformations. Materials and procedures Between April 2015 and July 2017, 46 embolization treatments for brain arteriovenous malformations (BAVM) were performed in 25 patients using two Squid formulations (18 and 12). Six female and 19 male patients with a mean age of 34 years (range, 9-62 years) were included. A total of 46 procedures were performed. The BAVMs were classified as Spetzler-Martin grade II in 4 procedures, III in 27 procedures, and 1V in 15 procedures. Among the 25 patients, 15 presented with hemorrhage, 5 with seizures, and 5 with headache and neurology. The BAVMs were located in the temporal lobe in 5 patients, parietal lobe in 7 patients, frontal lobe in 3 patients, posterior fossa in 6 patients, basal ganglia in 3 patients, and parasagittal lobe in 1 patient. Results The obliteration rate of the BAVMs ranged from 10% to 100%, with a mean of 33%. Most patients underwent their first or second embolization procedure. Four patients (8%) developed intracranial bleeding post-procedure, with one death (2%). One patient (2%) experienced a seizure during the procedure; however, no intracranial bleeding was observed. Seven patients (15%) experienced perforations during catheter manipulation. One case (2%) of a fractured catheter was recorded, but no significant complications were observed. The average volume of copolymer injected was 0.6 ml per nidus. Thirteen procedures used the Squid-12 formulation, 29 procedures used the Squid-18 formulation, and 3 procedures used a combination of Squid-12 and -18 formulations. Conclusion Squid is a safe and effective embolic agent for treating BAVMs.
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Affiliation(s)
- Li Shyan Ch'ng
- Radiology Department, Faculty of Medicine UiTM, Sungai Buloh, Malaysia
| | - Zulkifli Zaki
- Radiology Department, Hospital Sungai Buloh, Sungai Buloh, Malaysia
| | - Ahmad Sobri Muda
- Radiology Department, HSAAS, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Malaysia
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Deng X, Dong M, Peng C, Ding X, Wang K, Qin K, Chen G. Embolizing intracranial arteriovenous malformations with Onyx: experience at a single center with 250 patients. J Interv Med 2019; 1:164-169. [PMID: 34805845 PMCID: PMC8586546 DOI: 10.19779/j.cnki.2096-3602.2018.03.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Objective The aim of this study is to evaluate the embolization techniques, as well as the effects and complications, using the non-adhesive liquid embolic material Onyx in intracranial arteriovenous malformations (AVMs). Methods The study comprises a retrospective analysis of 250 patients with intracranial AVMs treated with Onyx in Guangdong General Hospital from Jan 2010 to Dec 2017. The therapeutic strategies, as well as embolization effects and complications, of Onyx are summarized. Results Of 250 cases, 170 were male and 80 were female. Following the Spetzler-Martin (S-M) grading system, there were 35 cases of grade I, 77 of grade II, 72 of grade III, 39 of grade IV, and 27 of grade V. All cases were treated with Onyx. In addition, 69 cases were treated with Glubran glue. The injected volume of Onyx per patient ranged from 1 mL to 10 mL. The largest volume of Onyx injected in one procedure was 10 mL. The cure rate was 67.9% (76/112) of grade I-II patients, 15.0% (11/72) of grade III patients, 7.7% (3/39) of grade IV patients, and 0% (0/27) of grade V patients. The total cure rate was 36.0% (90/250). The average number of targeted vascular branches per patient was 2.28. The microcatheter broke off in two cases. There were two patients who suffered an intracranial hemorrhage during the embolic procedure; in one of these two patients, the microcatheter also broke off. There were two patients who suffered an intracranial hemorrhage after the embolic procedure; one of them died. Seven cases suffered new-onset neurological deficits or their original symptoms deteriorated. Six of them improved or recovered within 3-6 months. The total complication rate was 5.2% (13/250). Conclusion The application of Onyx in intracranial AVMs is flexible, effective and safe, and may also reduce the complications.
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Affiliation(s)
- Xianming Deng
- Department of Neurosurgery, Guangdong General Hospital, Institute of Neuroscience, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province, China,Southern Medical University, Guangzhou, Guangdong Province, China
| | - Mengqi Dong
- Department of Neurosurgery, Guangdong General Hospital, Institute of Neuroscience, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province, China
| | - Chao Peng
- Department of Neurosurgery, Guangdong General Hospital, Institute of Neuroscience, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province, China
| | - Xiaowen Ding
- Department of Neurosurgery, Guangdong General Hospital, Institute of Neuroscience, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province, China
| | - Kun Wang
- Department of Neurosurgery, Guangdong General Hospital, Institute of Neuroscience, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province, China,Southern Medical University, Guangzhou, Guangdong Province, China
| | - Kun Qin
- Department of Neurosurgery, Guangdong General Hospital, Institute of Neuroscience, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province, China
| | - Guangzhong Chen
- Department of Neurosurgery, Guangdong General Hospital, Institute of Neuroscience, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province, China,Correspondence: Guangzhong Chen, 106# Zhongshan Er Road, Guangzhou 510080, China,
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Thaung C. Orbital pathology - Iatrogenic findings and artefacts. Saudi J Ophthalmol 2018; 32:17-22. [PMID: 29755266 PMCID: PMC5944018 DOI: 10.1016/j.sjopt.2018.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 02/01/2018] [Accepted: 02/08/2018] [Indexed: 12/01/2022] Open
Abstract
The relationship between the ophthalmologist and ophthalmic pathologist is particularly important in orbital disease, as diagnosis is heavily dependent on correlation with clinical context. If the patient has previously had treatment to the orbit or an adjacent area, whether for the same or a different condition, tissue changes may occur which affect the histological appearance of any specimen taken. This article is an overview of therapeutic interventions which may cause either orbital pathology or an altered appearance of the tissue, either of which can pose a diagnostic challenge. The problem of artefact is also addressed as another factor which may alter the appearance of a specimen. It is hoped that the information provided in this brief review will help clinicians better evaluate what information may be relevant when submitting a specimen.
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