Embolization of Intracranial Arteriovenous Malformations with Ethylene-Vinyl Alcohol Copolymer (Onyx)

• Published in: American journal of neuroradiology : AJNR Vol. 30; no. 1; pp. 99 - 108
• Main Authors: Panagiotopoulos, V, Gizewski, E, Asgari, S, Regel, J, Forsting, M, Wanke, I
• Format: Journal Article
• Language: English
• Published: Oak Brook, IL Am Soc Neuroradiology 01-01-2009; American Society of Neuroradiology
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Biological and medical sciences; Dimethyl Sulfoxide - therapeutic use; Embolization, Therapeutic - methods; Female; Humans; Interventional; Intracranial Arteriovenous Malformations - diagnostic imaging; Intracranial Arteriovenous Malformations - therapy; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Middle Aged; Nervous system; Polyvinyls - therapeutic use; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Radiography; Retrospective Studies; Treatment Outcome; Young Adult; Vascular disease; Intracranial; Nervous system diseases; Radiodiagnosis; Cardiovascular disease; Alcohol; Embolization; Congenital disease; Arteriovenous malformation
• ISSN: 0195-6108; 1936-959X
• DOI: 10.3174/ajnr.A1314

Endovascular therapy of intracranial arteriovenous malformations (AVMs) is increasingly used. However, it is still under discussion which embolic material is optimal. We report our experience in the treatment of AVMs with ethylene-vinyl alcohol copolymer (Onyx).
Between July 2002 and January 2008, brain AVMs were embolized with Onyx in 82 consecutive patients in our department. There were 41 females and 41 males with a mean age of 44.2 years (range, 15-85 years). Clinical presentation included symptoms due to intracerebral hemorrhage (n = 37), seizures (n = 18), nonhemorrhagic neurologic deficits (n = 8), headaches (n = 9), or incidental symptoms (n = 10). According to the Spetzler-Martin scale, 59 AVMs were grades I-II, 16 were grade III, and 7 were grades IV-V.
Complete obliteration at the end of all endovascular procedures was achieved in 20/82 patients (24.4%), with an average of 75% (range, 30%-100%) volume reduction. A mean of 2.9 (range, 1-10) feeding pedicles was embolized per patient, whereas an average of 2.6-mL Onyx was used per patient. Procedure-related permanent disabling morbidity was 3.8%, whereas mortality was 2.4%.
The overall initial complete obliteration rate of intracranial AVMs with Onyx embolization is relatively high, compared with other embolic agents, with evidence of stability with time. Morbidomortality rates due to AVM embolization as a single treatment method or as a part of a multimodality treatment should be further assessed regarding the natural course of the disease.