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Direct intraoperative confirmation of penetration of ethylene vinyl alcohol copolymer (Onyx) into the vasa nervosa of the facial nerve
  1. James Chen1,
  2. Benjamin Crane2,
  3. John Niparko2,
  4. Dheeraj Gandhi3,4
  1. 1Russell H. Morgan Department of Radiology, Division of Interventional Neuroradiology, Johns Hopkins Hospital, Baltimore, Maryland, USA
  2. 2Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
  3. 3Department of Radiology, University of Maryland, Baltimore, Baltimore, Maryland, USA
  4. 4Department of Neurology and Neurosurgery, University of Maryland, Baltimore, Maryland, USA
  1. Correspondence to Dr Dheeraj Gandhi, Professor of Radiology, Neurology and Neurosurgery, Director, Interventional Neuroradiology, University of Maryland, Baltimore 22 South Greene Street, Room G2K14, Baltimore, MD 21201, USA; dgandhi{at}


The case history is described of a patient referred to our institution with facial nerve palsy following embolization of a middle cranial fossa dural arteriovenous fistula using ethylene vinyl alcohol copolymer (EVOH). Facial nerve decompression was performed which showed evidence of extensive penetration of EVOH into the vasa nervosa of the facial nerve. Facial nerve palsy is a debilitating complication that can be avoided by attention to the lower cranial nerve arterial supply during careful procedural planning and consideration of alternative strategies for fistula obliteration in cases where eloquent feeders are involved.

  • Aneurysm
  • angiography
  • eye
  • malignant
  • MRI
  • CT
  • spinal cord
  • technique
  • complication
  • catheter
  • balloon
  • thrombolysis
  • stroke
  • stent
  • intervention
  • hemorrhage
  • embolic
  • coil
  • atherosclerosis
  • angioplasty

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  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval This study was approved by Johns Hopkins Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.