title: Safety and efficacy of onyx embolization for pediatric cranial and spinal vascular lesions and tumors.
abstract: BACKGROUND
  Although Onyx is widely used to embolize vascular lesions in adults, the safety and efficacy of this liquid embolic agent for use in children are not well studied.
  
  
  OBJECTIVE
  To report our experience using Onyx in pediatric patients for a variety of cranial and spinal vascular lesions and tumors to determine its procedural complication rates, types, and clinical consequences and to highlight the indications for and principles of Onyx embolization in pediatric patients.
  
  
  METHODS
  All pediatric Onyx embolization cases performed consecutively by the neuroendovascular services at our 2 institutions over a 5-year period were collected retrospectively and analyzed.
  
  
  RESULTS
  Over the study period, 105 Onyx embolization procedures were performed in 69 pediatric patients with a mean follow-up of 112 days. Fifty-two patients harbored "primary" vascular lesions (malformations, fistulas, etc), whereas 17 patients had tumors. Complications occurred in 25 of 105 procedures (23.8%) and included ischemic infarct (7), asymptomatic nontarget embolization (4), intracerebral hemorrhage (3), microcatheter-related vessel perforation (3), retained microcatheter (2), cerebral edema (2), dimethyl sulfoxide-induced pulmonary edema (2), facial ischemia (1), and contrast-induced bronchospasm (1). Neurological morbidity occurred transiently after 10 procedures (9.5%) and permanently after 2 procedures (1.9%). There were no procedure-related deaths. Statistical analysis revealed no predictors of complications among the multiple potential risk factors evaluated.
  
  
  CONCLUSIONS
  Our experience suggests that Onyx can be used effectively for embolization of pediatric cranial and spinal vascular lesions and tumors with low permanent morbidity; however, attention must be paid to the technical nuances of and indications for its use to avoid potential complications.
authors.affiliation: Department of Neurological Surgery, University of Miami Miller School of Medicine, Lois Pope LIFE Center, Miami, Florida 33136-1060, USA.
authors.forename: Ramsey
authors.initials: R
authors.lastname: Ashour
authors.forename: Mohammad Ali
authors.initials: MA
authors.lastname: Aziz-Sultan
authors.forename: Maryam
authors.initials: M
authors.lastname: Soltanolkotabi
authors.forename: Samantha E
authors.initials: SE
authors.lastname: Schoeneman
authors.forename: Tord D
authors.initials: TD
authors.lastname: Alden
authors.forename: Michael C
authors.initials: MC
authors.lastname: Hurley
authors.forename: Arthur J
authors.initials: AJ
authors.lastname: Dipatri
authors.forename: Tadanori
authors.initials: T
authors.lastname: Tomita
authors.forename: Mohamed Samy
authors.initials: MS
authors.lastname: Elhammady
authors.forename: Ali
authors.initials: A
authors.lastname: Shaibani
mesh_terms: D000293:Adolescent; D000792:Angiography; D020785:Central Nervous System Vascular Malformations / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000601:surgery; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010372:Pediatrics; D011145:Polyvinyls / Q000627:therapeutic use*; D011183:Postoperative Complications; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D011145:Polyvinyls; C020320:ethylene-vinyl alcohol copolymer