Facial Artery High Flow Fistula Embolization from a Right Mandibular Hypervascular ABC

¹Anis Nassif

¹Lebanese American University

Background:

We would like to present for discussion a rare case of a 9 y old girl of a facial artery to facial vein high flow fistula secondary a hypervascular aneurysmal bone cyst ( ABC ) in the right mandible eroding into the facial artery mimicking an AVM . We embolized the fistula with Onyx 18 liquid embolic prior to surgical resection. This young child is devastated after failing 2 previous surgical resections secondary significant blood loss in the OR.

Material(s) and Method(s):

Using a tri axis approach , we advanced a Sonic microcatherter with 25 mm detachable tip over a Hybrid .08 microwire with a J curve tip into the foot of the facial vein at the level of the fistula and embolized it with 7.5 cc or 5 vials of Onyx 18 with significant decrease in vascularity.

The microcather was pulled out and the tip was detached and left in the liquid embolic.

Result(s):

The fistula was successfully embolized and devascularised in order to allow the surgeons to resect the ABC in the right mandible in this 9 y old girl . She had failed 2 prior surgical attempts secondary high loss of blood in the operating room.

Conclusion(s):

An ABC can erode into the adjacent artery and result in a high flow fistula . Pre surgical embolization is an adequate method to successfully treat and resect the ABC and reconstruct the mandible in this young child.