We describe a rare neurointerventional complication, namely a stretched and sheared microcatheter, extending 52 cm from its point of retention within an Onyx cast in an infant patient's neck mass, to the groin. The tumor was an unusual manifestation of infantile myofibromatosis and prior attempts at resection had proven impossible due to bleeding. Recommendations regarding microcatheter selection, diagnostic workup, and management of the ensuing complication are given.
BendszusMKleinRBurgerR. Efficacy of trisacryl gelatin microspheres versus polyvinyl alcohol particles in the preoperative embolization of meningiomas. Am J Neuroradiol. 2000; 21 (2): 255–261.
2.
van RooijWJSluzewskiMBeuteGN. Brain AVM embolization with Onyx. Am J Neuroradiol. 2007; 28 (1): 172–177; discussion 177.
3.
WeberWKisBSiekmannR. Endovascular treatment of intracranial arteriovenous malformations with onyx: Technical aspects. Am J Neuroradiol. 2007; 28 (2): 371–377.
4.
AratACilBEVargelI. Embolization of high-flow craniofacial vascular malformations with onyx. Am J Neuroradiol. 2007; 28 (7): 1409–1414.
5.
RezendeMTPiotinMMounayerC. Dural arteriovenous fistula of the lesser sphenoid wing region treated with Onyx: Technical note. Neuroradiology. 2006; 48 (2): 130–134.
6.
GorePTheodoreNBrasilienseL. The utility of onyx for preoperative embolization of cranial and spinal tumors. Neurosurgery. 2008; 62 (6): 1204–1211; discussion 11–2.
7.
ElhammadyMSWolfeSQAshourR. Safety and efficacy of vascular tumor embolization using Onyx: Is angiographic devascularization sufficient?J Neurosurg. 2009; 112 (5): 1039–1045.
8.
BingolHSirinGAkayHT. Management of a retained catheter in an arteriovenous malformation. Case report. J Neurosurg. 2007; 106 (3): 481–483.
9.
ThiexRWilliamsASmithE. The use of Onyx for embolization of central nervous system arteriovenous lesions in pediatric patients. Am J Neuroradiol. 2009; 31 (1): 112–120.
10.
FrizzelRTFisherWS3rd. Cure, morbidity, and mortality associated with embolization of brain arteriovenous malformations: A review of 1246 patients in 32 series over a 35-year period. Neurosurgery. 1995; 37 (6): 1031–1039; discussion 1039–1040.
11.
PelzDMFoxAJVinuelaF. Preoperative embolization of brain AVMs with isobutyl-2 cyanoacrylate. Am J Neuroradiol. 1988; 9 (4): 757–764.
12.
WhittleIRJohnstonIHBesserM. Experience with bucrylate (isobutyl-2-cyanoacrylate) embolization of cerebral arteriovenous malformations during surgery. Surg Neurol. 1983; 19 (5): 442–449.
13.
ZoarskiGHLillyMPSperlingJS. Surgically confirmed incorporation of a chronically retained neurointerventional microcatheter in the carotid artery. Am J Neuroradiol. 1999; 20 (1): 177–178.
14.
KellyMETurnerRTGonuguntaV. Monorail snare technique for the retrieval of an adherent microcatheter from an onyx cast: Technical case report. Neurosurgery. 2008; 63 (1Suppl 1): ONSE89; discussion ONSE.