Shoulder pain relieved by root canal.

The authors report a 73-year-old man with moderately severe shoulder pain of 6 months' duration. The pain resolved suddenly and completely with root canal in a premolar tooth ipsilateral to the shoulder, and the patient has remained pain-free over the ensuing 6 months.

Trigeminocardiac reflex in a child during pre-Onyx DMSO injection for juvenile nasopharyngeal angiofibroma embolization. A case report.

We describe the occurrence of the trigeminocardiac reflex (TCR) during DMSO pre-flushing of the microcatheter in preparation for Onyx embolization via the internal maxillary artery. TCR has not been previously associated with embolization of extradural entities. Familiarity with this clinical reflex and its proper management may help in planning neurointerventional procedures involving DMSO injection in the trigeminal territory.

Stretched and sheared microcatheter retained after onyx embolization of infantile myofibromatosis.

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.

Safety and clinical efficacy of Onyx for embolization of extracranial head and neck vascular anomalies.

BACKGROUND AND PURPOSE: Onyx was developed for embolization of central nervous system AVMs but is increasingly used extracranially because of its unique physical properties. We review our experience and results with the use of Onyx for the treatment of fast-flow extracranial vascular lesions. MATERIALS AND METHODS: We retrospectively analyzed clinical and imaging records of 22 patients who underwent 71 extracranial embolizations from March 2007 through January 2010. The diagnoses were the following: cervicofacial AVM (n = 18), traumatic fistula (n = 3), and vessel laceration (n = 1). In 62 of 71 procedures (87%), Onyx was the sole embolic agent; it was delivered transarterially in 67/71 and percutaneously in 4/71 procedures. Clinical goals included amelioration of pain and control of bleeding. The clinical efficacy of embolization was judged by symptom control, and adverse events were assessed by clinical examination and history, both postembolization and 4 weeks postprocedure. RESULTS: Cessation of acute bleeding was achieved in 13/14 cases, with 1 case of immediate recurrent massive epistaxis prompting reintubation and further embolization. Control of subacute bleeding episodes and pain was achieved for all patients. Following staged embolization, 7 patients underwent surgical resection without significant blood loss. Surgeons reported high satisfaction with the intraoperative handling properties of Onyx. Transient swelling, local tenderness, or numbness was encountered after 7 procedures. There were no stuck catheters, vessel dissections, or vessel ruptures and no skin discoloration. CONCLUSIONS: Staged Onyx embolization was clinically efficacious in managing extracranial fast-flow vascular malformations and lesions, with low associated morbidity.

The use of Onyx for embolization of central nervous system arteriovenous lesions in pediatric patients.

BACKGROUND AND PURPOSE: The safety and efficacy of Onyx for the embolization of central nervous system (CNS) arteriovenous (AV) lesions have been widely reported in adults. However, data describing the use of this agent in children are limited. This study presents our experience with Onyx in the treatment of CNS AV lesions in pediatric patients. MATERIALS AND METHODS: We retrospectively analyzed clinical and imaging records of 15 pediatric patients who underwent 36 transarterial embolizations by using Onyx for CNS AV lesions, from March 2007 through April 2009 at our institution. Underlying pathologies included brain AV malformations (AVMs) (n = 7), vein of Galen malformations (n = 4), dural AV fistulas (n = 2), and spinal AVMs (n = 2). For 7 procedures in very high-flow lesions, detachable coils were deployed before Onyx embolization, whereas in 29 procedures, Onyx was the sole embolic agent. The efficacy of embolization was judged by the residuum of AV shunting within the target region. RESULTS: Embolization was complete in 2 patients, nearly complete in 9 patients, and partial (and ongoing) in 4 patients. Following staged embolization, 7 patients underwent surgical resection without significant blood loss and with good functional outcome in all cases. Clinically silent non-target embolization was encountered in 2 of 36 procedures. After 3 of the 36 embolizations, patients developed transient neurologic symptoms, all of which resolved to baseline within 24 hours. There were no non-neurologic adverse events. There was no imaging evidence of infarct or hemorrhage. CONCLUSIONS: Onyx embolization of pediatric CNS AV lesions can be an efficacious treatment technique, with extremely low associated morbidity.