Preoperative Embolization of Intracranial Arteriovenous Malformations With Onyx

Abstract

Preoperative use of the Onyx liquid embolic system in cerebral AVM treatment allows profound occlusion by targeted embolization and provides a basis for safe neurosurgical resection.

Preoperative Embolization of Cerebral Arteriovenous Malformations with Onyx

“…1,4,[8][9][10][11][12] At that time, the morbidity and mortality rates with preoperative embolization ranged from 3.8% and 1.0% to 28% and 3.7%, respectively. Similar to other investigators, with use of Onyx, our results of a permanent morbidity rate of 12.2% and no deaths after preoperative Onyx embolization are within that range ( 7,17 In the first study, Weber et al examined the morbidity rate in 93 patients treated with Onyx for cAVMs, which apparently was 12% per patient, with no deaths. In a second consecutive study with 47 patients, they documented an even higher morbidity rate of 28%.…”

“…Volume reduction was then determined on the basis of postembolization angiography. Weber et al 7,17 achieved an 80% to 84% volume reduction with a considerably high morbidity rate. In their presentation, Ann H. Costello and Judy Chen quote a volume reduction of Ն 50% in 97.6% (41/42) of the patients after embolization with Onyx compared with 84.3% (43/51) with n-BCA (unpublished data).…”

“…Possibly because of these limitations, some studies with Onyx did not present precise measurements regarding volume reduction. [14][15][16] We measured the volume reduction of the cAVM postembolization in categories according to Weber et al 7,17 They calculated the AVM volume on the basis of standard arteriography with the formula suggested by Pasqualin et al 18 : V ϭ 1 ⁄2 ϫ w ϫ h ϫ l [V ϳ volume, w ϳ width, h ϳ height, l ϳ length]. Volume reduction was then determined on the basis of postembolization angiography.…”

“…With 2 competing goals, sacrifice of the draining vein(s) for cure versus preservation of the venous outflow with size reduction in preparation for additional treatment, the reported "cure" rates between different centers varies considerably (from 0% to 28%). 7,[13][14][15][16][17]19 At our institution, "cure" is typically not the goal of the preoperative embolization. Complete occlusion of the cAVM was achieved in 10%.…”

Central Nervous System Vascular Malformations

“…Complete occlusion of an AVM is rarely achieved with endovascular treatment alone, with most published angiographic cure rates ranging from 16-28% [92][93][94][95][96][97]. Many of the angiographic cures are in small AVMs, with very few complete occlusions in SM grade 3 AVMs or larger.…”