Onyx embolization for the treatment of brain arteriovenous malformations

Acta Neurochir (2011) 153:869–878. DOI 10.1007/s00701-010-0848-6

Onyx has emerged in recent years for the endovascular treatment of brain arteriovenous malformations (AVMs). However, the role of Onyx embolization is still under discussion. We report our initial experiences in the treatment of brain AVMs with Onyx embolization.

Methods Between January 2004 and December 2007, 86 patients with brain AVMs were embolized with Onyx. Clinical presentation included intracerebral hemorrhage in 32 patients, seizures in 25 patients, headaches in 20 patients, neurologic deficits in 3 patients, and in 6 patients the AVM was an incidental finding. According to the Spetzler–Martin scale, three AVMs were grade I, 13 were grade II, 45 were grade III, 19 were grade IV, and 6 were grade V. Seventy-four AVMs were located in eloquent regions.

Results Initial complete obliteration after final embolization was achieved in 16 patients (18.6%), with an average of 80.5% (range, 30–100%) volume reduction. Partial embolization was followed by surgery in 18 patients, whereas 17 AVMs were cured. In 48 patients treated by embolization and radiosurgery, four patients were lost to follow-up. Three-year follow-up angiography was performed on 30 patients and showed complete obliteration after radiosurgery in 23 patients. The remaining 14 patients are awaiting 3-year postradiosurgery results. Embolization-related permanent morbidity was 3.5%, whereas mortality was 1.2%.

Conclusions Although Onyx allows moderate obliteration rates, combined management, such as adjunctive embolization with microsurgery or radiosurgery, may be effective for selected large AVMs.

Endovascular treatment of brain arteriovenous malformations using onyx: Results of a prospective, multicenter study

Journal of Neuroradiology (36) 3: 147 152 (01/06/2009)

Background and purpose. – To evaluate the safety and efficacy of onyx for embolization of brain arteriovenous malformations (BAVM). Methods. – A prospective, multicenter study was conducted in France to evaluate embolization of BAVM with onyx. From May 2003 to March 2005, 50 patients (26 females, 24 mates; mean age: 34.8 years, range: 16-64 years) were included. Clinical. Presentation was haemorrhage in 22 patients (44.0%), seizures in 16 patients (32.0%), headaches in six patients (12.0%) and progressive neurological. Deficit in two cases (4.0%). Four patients were asymptomatic (8.0%). Results. – One hundred and forty-nine sessions of embolization were performed: one to eight sessions/patient with a mean of 3.0 sessions. One hundred and sixteen sessions (77.9%) were performed with onyx, 20 sessions (13.4%) with glue and 13 sessions (8.7%) with onyx and glue. Symptomatic acute postembolization haemorrhage (APEH) was observed in four cases (8.0% per patient). At 1 month, morbidity and mortality related to the treatment were of 8% and 2%, respectively. Complete BAVM occlusion was obtained in 8.3% of cases. In the remaining cases, occlusion rate was between 99 and 80% in 56.3% of patients, 79 and 60% in 16.7%, and less than 60 in 18.7%. In case of incomplete occlusion, complementary treatment was performed by radiosurgery. Conclusion. – Onyx is suitable for BAVM embolization with acceptable morbidity and mortality.

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