title: A Case Report of Onyx Pulmonary Arterial Embolism Contributing to Hypoxemia During Awake Craniotomy for Arteriovenous Malformation Resection.
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.
authors.affiliation: From the Departments of *Anesthesiology, †Neurology, and ‡Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill.
authors.forename: Brian T
authors.initials: BT
authors.lastname: Tolly
authors.forename: Jenna L
authors.initials: JL
authors.lastname: Kosky
authors.forename: Antoun
authors.initials: A
authors.lastname: Koht
authors.forename: Laura B
authors.initials: LB
authors.lastname: Hemmer
mesh_terms: D000328:Adult; D000072226:Computed Tomography Angiography; D003399:Craniotomy; D004121:Dimethyl Sulfoxide / Q000009:adverse effects*; D004621:Embolization, Therapeutic / Q000009:adverse effects*; D057510:Endovascular Procedures; D006801:Humans; D000860:Hypoxia / Q000209:etiology*; D002538:Intracranial Arteriovenous Malformations / Q000628:therapy*; D007431:Intraoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology*; D008297:Male; D011145:Polyvinyls / Q000009:adverse effects*; D011651:Pulmonary Artery / Q000000981:diagnostic imaging*; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging / Q000209:etiology*; D013635:Tantalum / Q000009:adverse effects*; D014057:Tomography, X-Ray Computed
chemical_list: C000598428:Onyx 34; D011145:Polyvinyls; D013635:Tantalum; D004121:Dimethyl Sulfoxide