Isolated Hypoglossal Nerve Palsy Due to Endovascular Treatment of a Dural Arteriovenous Fistula with Onyx-18

Abstract

<jats:p> We describe a patient with dural arteriovenous fistula (DAVF) treated with Onyx-18 who developed isolated hypoglossal nerve palsy. This is the first case of isolated hypoglossal nerve palsy caused by Onyx-18 embolization. This complication suggests that over embolization with Onyx-18 in the treatment of hypoglossal canal DAVFs should be avoided, and transvenous embolization may be safer. Furthermore, prednisolone therapy should be carried out in the prophase of nerve palsy. </jats:p>

Transvenous Embolization of Dural Arteriovenous Fistulas of the Hypoglossal Canal: Report of Three Cases and Review of the Literature

“…There are some reports showing that overpacking the ACV may result in hypoglossal nerve palsy due to mass effect on the hypoglossal nerve as in our first case presented [3, 8, 9]. The damage to the hypoglossal nerve can be permanent [3, 8, 18] or transient [8, 16, 20]. …”

“…Ernst et al [9] reported a case of a patient with ipsilateral proptosis and chemosis due to retrograde filling of the IPS and cavernous sinus to the superior ophthalmic vein that developed 2 years after transarterial embolization with polyvinyl alcohol of a HCDAVF. But the most concerning risk of transarterial approach is inadvertent embolization to the ICA or VA through extracranial-intracranial anastomoses causing cerebral infarction and/or lower cranial nerve palsy [9, 18] (Table 1). …”

“…Takemoto et al [16] reported 3 cases of transvenous embolization of a HCDAVF with Onyx that had excellent results. However, there are potential adverse effects associated with Onyx including direct neurotoxicity from dimethyl sulfoxide and retrograde reflux of Onyx into the feeding arteries [16, 18]. …”

Endovascular Modalities for the Treatment of Cavernous Sinus Arteriovenous Fistulas: A Single-Center Experience

“…Similar complications of Onyx could happen when injecting it in ECA feeders supplying brain arteriovenous malformation or cranial dural arteriovenous fistula as previously reported in the literature. [57][58][59][60][61] …”

Endovascular Treatment of Dural Arteriovenous Fistulas of the Anterior or Posterior Condylar Vein

“…4a, b). Although there are reported cases of IX-XII cranial nerve dysfunctions after transarterial embolization of DAVFs in the region of the ACV [18], this anatomical fact is a possible explanation why hypoglossal nerve injury is not a frequently observed therapeutic injury.…”