Onyx® in endovascular treatment of cerebral arteriovenous malformations – a review

Abstract

SummaryArteriovenous malformation (AVM) is an abnormal connection between arteries and veins, bypassing the capillary system. In most cases, the disorder may be asymptomatic. The objective of endovascular AVM treatment is set individually for each case upon consultations with a neurosurgeon and a neurologist. The endpoint of the treatment should consist in prevention of AVM bleeding in a management procedure characterized by a significantly lower risk of complications as compared to the natural history of AVM. Endovascular interventions within AVM may include curative exclusion of AVM from circulation, embolization adjuvant to resection or radiation therapy, targeted closure of a previously identified bleeding site as well as palliative embolization. Onyx was first described in the 1990s. It is a non-adhesive and radiolucent compound. Onyx-based closure of the lumen of the targeted vessel is obtained by means of precipitation. The process is enhanced peripherally to the main flux of the injected mixture. This facilitates angiographic monitoring of embolization at any stage. The degree of lumen closure is associated with the location of the vessel. Supratentorial and cortical locations are most advantageous. Dense and plexiform structure of AVM nidus as well as a low number of supplying vessels and a single superficial drainage vein are usually advantageous for Onyx administration. Unfavorable factors include nidus drainage into multiple compartments as well as multiarterial supply of the AVM, particularly from meningeal arteries, en-passant arteries or perforating feeders. Onyx appears to be a safe and efficient material for embolization of cerebral AVMs, also in cases of intracranial bleeding associated with AVM. Curative embolization of small cerebral AVMs is an efficient and safe alternative to neurosurgical and radiosurgical methods. Careful angiographic assessment of individual arteriovenous malformations should be performed before each Onyx administration.

Tratamiento de malformaciones y tumores vasculares, en un centro de referencia en Bogotá

“…Las microesferas y micropartículas no se emplearon en ningún caso, pero están descritas en el tratamiento de algunas anomalías vasculares, aunque por su rápida aglutinación y fácil circulación sistémica pueden tener complicaciones; si se utilizan, deben acompañarse de otros métodos de oclusión endovascular 40,41 . Algunos medicamentos, como la bleomicina o la tetraciclina, se han usado especialmente para el manejo de malformaciones linfáticas, pero su índice de complicaciones no es despreciable, por lo que se recomienda el uso de otras alternativas [42][43][44] .…”

Onyx™ embolization for an angiographically progressive traumatic pseudoaneurysm of the middle meningeal artery: A case report and literature review

“…Onyx™ is an ethylenevinyl alcohol co-polymer dissolved in DMSO with added micronized tantalum powder to provide radiopacity (30). A major advantage of Onyx™ is its non-adherence to the catheter and vessel, which allows the operator to inject the substance slowly and with more precision; this facilitates real-time monitoring for reflux and precludes the concern for catheter adhesion (27).…”

Gamma knife radiosurgery for arteriovenous malformations: general principles and preliminary results in a Swiss cohort

“…Microsurgical treatment completely obliterates high-grade AVMs in 57 to 100% of cases, with non-negligible mortality rates of between 0 and 11% and higher morbidity rates of between 4 and 85% (higher for higher Spetzler-Martin grades III-V) [32]. Combined endovascular and surgical treatment allows higher obliteration rates, of between 83 and 100%, with a complication rate of 15.4% [33,34]. With embolisation alone, AVM volume reduction is achieved in 79.5% and complete obliteration in 20% of cases, with a complication rate of 12% (range 8-40%) [35].…”