Embolizing intracranial arteriovenous malformations with Onyx: experience at a single center with 250 patients

Abstract

Objective The aim of this study is to evaluate the embolization techniques, as well as the effects and complications, using the non-adhesive liquid embolic material Onyx in intracranial arteriovenous malformations (AVMs). Methods The study comprises a retrospective analysis of 250 patients with intracranial AVMs treated with Onyx in Guangdong General Hospital from Jan 2010 to Dec 2017. The therapeutic strategies, as well as embolization effects and complications, of Onyx are summarized. Results Of 250 cases, 170 were male and 80 were female. Following the Spetzler-Martin (S-M) grading system, there were 35 cases of grade I, 77 of grade II, 72 of grade III, 39 of grade IV, and 27 of grade V. All cases were treated with Onyx. In addition, 69 cases were treated with Glubran glue. The injected volume of Onyx per patient ranged from 1 mL to 10 mL. The largest volume of Onyx injected in one procedure was 10 mL. The cure rate was 67.9% (76/112) of grade I-II patients, 15.0% (11/72) of grade III patients, 7.7% (3/39) of grade IV patients, and 0% (0/27) of grade V patients. The total cure rate was 36.0% (90/250). The average number of targeted vascular branches per patient was 2.28. The microcatheter broke off in two cases. There were two patients who suffered an intracranial hemorrhage during the embolic procedure; in one of these two patients, the microcatheter also broke off. There were two patients who suffered an intracranial hemorrhage after the embolic procedure; one of them died. Seven cases suffered new-onset neurological deficits or their original symptoms deteriorated. Six of them improved or recovered within 3-6 months. The total complication rate was 5.2% (13/250). Conclusion The application of Onyx in intracranial AVMs is flexible, effective and safe, and may also reduce the complications.

Keywords: Onyx; complication; embolization treatment; intracranial arteriovenous malformations; treatment outcome.

Figure 1

Image data before and after embolization. (a) CT scan showing the change of mixed density of the right temporal lobe. (b) CTA showing that the AVM was located in the right temporal lobe. (c)–(e) DSA showing feeding arteries, an AVM nidus, and draining veins. The AVM was supplied by multiple vessels of the middle cerebral artery. (f) There were several residual lesions that had remained untreated. (g) Onyx formed a mold in the nidus. (h)–(i) DSA showing that the residual AVM had disappeared completely.