Artikel
Endovascular treatment of cerebral arteriovenous malformations with ethylene-vinyl alcohol copolymer (Onyx): A single-center experience
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Veröffentlicht: | 28. April 2011 |
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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.