Embolization of Intracranial Arteriovenous Malformations Using Onyx in 53 Patients

Abstract

Background: Endovascular embolization is one of the main modalities in the treatment of brain arteriovenous malformations (AVMs). Onyx (ethylene-vinyl alcohol copolymer) is a new embolic agent with some advantages of slow injection and better control of penetration. Objectives: To report our experience in the embolization of brain AVMs with Onyx. Patients and Methods: From August 2012 to October 2014, 53 consecutive patients harboring brain AVM were treated with Onyx as the sole embolic agent during 85 procedures. There were 27 males and 26 females with a mean age of 27.2 years (range, 8 -65 years). Results: The presenting symptom was headache in 25 (47%), neurological deficit in 18 (35%), and seizure in ten (18%) patients. According to the Spetzler-Martin grading scale, three of the AVMs were ranked as grades I, 11 as grade II, 22 as grade III, 14 as grade IV, and three as grade V. An average of 1.8 feeding pedicles were embolized in each case, whereas a mean of 2.23-mL Onyx was used per patient. Initial complete obliteration at the end of all embolization procedures was achieved in 11 patients (20.08%). The rate of complete embolization at 6-month follow-up was 15%. After completion of embolization, the neurologic status was unchanged or improved in 46 (87%) patients. We observed treatment-related neurologic deficit in seven (13%) patients, of whom five were permanent (10%). There was no procedure-related death. Conclusion: Our experience with Onyx used for embolizing AVMs was satisfactory. Controlled injections that protect the draining veins make the therapy safe even in complex AVMs.

Liquid Embolic Agents for Endovascular Embolization: A Review

“…In 1990, Taki et al developed an EVA-based embolic agent which was clinically applied in three cases of AVM embolization successfully [16]. Since then, Onyx ® has been used successfully for the treatment of cerebral AVMs [125][126][127][128], peripheral AVMs [129][130][131][132], AVFs [11,12,17,133,134], intracranial aneurysms [22,24,135,136], renal artery aneurysm [1,140], bleeding from ruptured aneurysms [138,139], endoleaks [25,[140][141][142][143][144][145][146][147][148][149][150], and preoperative embolization [18,19,25,[151][152][153].…”

“…In 2013, Soltanolkotabi et al reported Onyx embolization of intracranial AVMs in 25 pediatric patients and suggested that Onyx embolization can be performed safely with a low rate of permanent morbidity [126]. In 2017, Aoude et al reported the treatment of brain AVMs with Onyx for 53 patients, where they found the results to be satisfactory with a complete obliteration rate of 20.08% [127]. In 2017, Singfer et al described primary Onyx embolization (with or without radiosurgery) in 61 patients with unruptured brain AVMs with a high occlusion rate [128].…”

Embolization of brain arteriovenous malformations with squid co-polymer embolic material: Initial experience

“…The draining veins were occluded when the nidus was completely filled. 2 We ensured that the reflux was always kept below the permitted limit for conventional microcatheters (2 ​cm) and that the acceptable reflux for detachable tip microcatheters was up to 5 ​cm, depending on the fusion length. After satisfactory embolization was achieved, the microcatheter was removed using backward tugging ( Fig.…”

Endovascular Embolization of Ruptured Intracranial Arteriovenous Malformation: A Retrospective Analytic Study

“…Onyx (ethylene-vinyl alcohol copolymer) is a lava-like, non-adhesive embolic agent and has several advantages over acrylic glue. It permits theoretically slower filling, better penetration, and obliteration of the nidus, providing a solid nidus cast due to its longer polymerization time and lack of adherence (5) .…”