Onyx In Brain Arteriovenous Malformation Embolization

Introduction: Embolisation has long been used as an adjunct to surgical resection in the treatment of brain arteriovenous malformation (bAVM). The most commonly used embolic material, n-butylcyanoacrylate glue, requires experience and skill to handle its quick and unpredictable flow and polymerisation. A new liquid embolic agent, ethylene vinyl alcohol copolymer (Onyx), is less adhesive and polymerises slowly, which provides better control for radiologists performing embolisation. Objective: To report our experience in embolisation using Onyx alone or in combination with histoacryl for bAVM embolisation in our tertiary referral centre. Methods: We retrospectively reviewed the anatomy, technical conditions, complications and clinical outcome of all bAVM patients embolised at our centre using Onyx alone or in combination with n-butylcyanoacrylate glue. Results: Between 2010 and 2013, 13 patients [6 (46.2%) male; 7 (53.8%) female; aged, 14– 57 years] were included, and a total of 31 embolisations were performed. Clinical presentation included hemorrhage [9 (69.2%)], seizures [2 (15.4%)], and headache [2 (15.4%)]. Most AVMs were located in the brain hemispheres [12 (92.3%)] and measured <3 cm [7 (53.8%]. Complete occlusion of the AVM was obtained in 2 (15.4%) patients; 11 (84.6%) patients had partial occlusion [6 (54.5%) had <50% nidus occlusion]. Complications occurred in four procedures involving 3 patients (morbidity, 23.1%). This resulted in the death of 1 patient (mortality, 7.7%) and complete recovery with no disability in 2 patients. Conclusion: The total nidal occlusion achieved herein is comparable to other similar studies. Our morbidity and mortality were higher compared to other studies which may be attributed to the small number of patients. More data is being collected which may better reflect on our experience.

Colon Cancer Recurrence Mimicking Renal Cell Carcinoma

Colorectal cancer (CRC) is one of the most common gastrointestinal cancers in the world. In Malaysia, it is the third most common cancer for both men and women. Curative surgical resection with en bloc removal of the regional lymph nodes remains the mainstay of treatment with 5-year survival rate of 70%-90% for local disease. 1 Nonetheless, about 1 in 3 curatively treated CRC patient will suffer from local recurrence or metastasis . 2 Among the usual sites of recurrence are liver, lungs, local and/or regional intraabdominal and retroperitoneal lymph nodes. 3 We report a rare case of colon cancer recurrence to the left kidney after curative surgery and adjuvant therapy, which mimicked left renal cell carcinoma.