title: Possible toxicity following embolization of congenital giant vertex hemangioma: case report.
abstract: The authors describe the case of a 3-year-old boy with a giant congenital vertex hemangioma who underwent presurgical embolization with Onyx (ethylene-vinyl alcohol copolymer dissolved in dimethyl sulfoxide) and Glubran ( N-butyl-2-cyanoacrylate). This vascular tumor had no intracranial vascular communication as assessed by pre-embolization MRI and catheter angiography. All embolizations were performed by direct percutaneous injection. One week following the last embolization procedure the child presented with a 24-hour history of ataxia and extrapyramidal tremor. He was diagnosed with a possible immune-mediated reaction to Onyx or Glubran, which was treated with an urgent surgical excision of the hemangioma followed by intravenous administration of immunoglobulin and steroids. To the authors' knowledge, this is the first case of possible immune-mediated toxicity secondary to either Onyx or Glubran administration. This case highlights the need for awareness of potential toxic reactions to these embolic agents in the treatment of hemangiomas in the pediatric patient.
authors.affiliation: Departments of 1 Plastic and Craniofacial Surgery.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Kieran
authors.affiliation: Neurosurgery.
authors.forename: Zaitun
authors.initials: Z
authors.lastname: Zakaria
authors.affiliation: Neurosurgery.
authors.forename: Chandrasekaran
authors.initials: C
authors.lastname: Kaliaperumal
authors.affiliation: Pediatric Neurology, and.
authors.forename: Declan
authors.initials: D
authors.lastname: O'Rourke
authors.affiliation: Department of Neuroradiology, Beaumont Hospital, Dublin, Ireland.
authors.forename: Alan
authors.initials: A
authors.lastname: O'Hare
authors.affiliation: Radiology, Temple Street Children's University Hospital; and.
authors.forename: Eoghan
authors.initials: E
authors.lastname: Laffan
authors.affiliation: Neurosurgery.
authors.forename: John
authors.initials: J
authors.lastname: Caird
authors.affiliation: Pediatric Neurology, and.
authors.forename: Mary D
authors.initials: MD
authors.lastname: King
authors.affiliation: Departments of 1 Plastic and Craniofacial Surgery.
authors.forename: Dylan J
authors.initials: DJ
authors.lastname: Murray
mesh_terms: D002675:Child, Preschool; D004621:Embolization, Therapeutic / Q000009:adverse effects*; D006392:Hemangioma, Cavernous / Q000000981:diagnostic imaging* / Q000628:therapy*; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000000981:diagnostic imaging / Q000628:therapy; D008297:Male; D009422:Nervous System Diseases / Q000139:chemically induced* / Q000175:diagnosis; D011145:Polyvinyls / Q000009:adverse effects*
chemical_list: D011145:Polyvinyls; C020320:ethylene-vinyl alcohol copolymer
keywords: AVM = arteriovenous malformation; IVIG = intravenous immunoglobulin; NICH = noninvoluting congenital hemangioma; congenital; embolic agent; embolization; hemangioma; toxicity; vascular disorders