gms | German Medical Science

62nd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Polish Society of Neurosurgeons (PNCH)

German Society of Neurosurgery (DGNC)

7 - 11 May 2011, Hamburg

Endovascular treatment of cerebral arteriovenous malformations with ethylene-vinyl alcohol copolymer (Onyx): A single-center experience

Meeting Abstract

  • T. Schmidt - Neurochirurgische Klinik der Universität Ulm, Bezirkskrankenhaus Günzburg
  • B. Schmitz - Sektion Neuroradiologie der radiologischen Klinik der Universität Ulm
  • G. Antoniadis - Neurochirurgische Klinik der Universität Ulm, Bezirkskrankenhaus Günzburg
  • C.R. Wirtz - Neurochirurgische Klinik der Universität Ulm, Bezirkskrankenhaus Günzburg
  • R.W. König - Neurochirurgische Klinik der Universität Ulm, Bezirkskrankenhaus Günzburg

Deutsche Gesellschaft für Neurochirurgie. Polnische Gesellschaft für Neurochirurgen. 62. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgen (PNCH). Hamburg, 07.-11.05.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. DocMO.10.05

doi: 10.3205/11dgnc070, urn:nbn:de:0183-11dgnc0709

Published: April 28, 2011

© 2011 Schmidt et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Objective: Endovascular treatment of arteriovenous malformations of the brain (BAVM) is increasingly used. We report on our experience in the treatment of BAVMs with ethylene-vinyl alcohol copolymer (Onyx).

Methods: Between January 2006 and December 2010, BAVMs were embolized with Onyx in 21 consecutive patients in our department. There were 13 females and 8 males with a mean age of 39 years (range, 18–57 years) who underwent a total of 41 sessions of embolization. Clinical presentation was hemorrhage in 5 patients (24.0%), chronic headaches in 8 patients (38.0%), and seizures in 4 patients (19.0%). Four patients were asymptomatic (19.0%). According to the Spetzler-Martin scale, 86% BAVMs were grade I–III, whereas 14% of these patients harbored Spetzler-Martin grades IV–V BAVMs.

Results: Complete obliteration at the end of all endovascular procedures was achieved in 5 patients (23.8%). Subtotal occlusion defined by volume reduction greater than 90% was obtained in 5 patients (23.8%). In case of incomplete occlusion, complementary treatment was performed by neurosurgery or radiosurgery. A mean of 4.3 mL (range, 0.5–12 mL) Onyx was used per session. Procedure-related permanent disabling morbidity was 9.5%, whereas mortality was 0%.

Conclusions: With knowledge of the morphologic and hemodynamic characteristics of BAVMs, high rates of total or subtotal occlusion can be achieved with multiple sessions of Onyx embolization with acceptable rates of morbidity and mortality. Superselective intranidal or perinidal catheter positions and slow, controlled injections that protect the draining veins make the therapy safe even in complex AVMs and at critical locations.