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Updated: Jul 2, 2026
Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Treatment of pediatric intracranial vascular malformations using Onyx-18
Brian T Jankowitz1, Nirav Vora, Tudor Jovin
1Department of Neurosurgery, Minimally Invasive endoNeurosurgery Center, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
Insights
Onyx-18 is a feasible liquid embolic agent for pediatric intracranial vascular malformations. Further long-term studies are needed to confirm its safety and efficacy in children.
Area of Science:
- Neurology
- Pediatric Neurosurgery
- Interventional Radiology
Background:
- The safety and efficacy of Onyx-18, a liquid embolic agent, in pediatric patients with intracranial vascular malformations require further investigation.
- Limited data exist on its use in this specific population.
Observation:
- This study evaluated the use of Onyx-18 in 6 pediatric patients (1 day to 12 years old) with cerebral vascular malformations between December 2005 and January 2008.
- Malformations included 4 arteriovenous malformations and 2 vein of Galen malformations, presenting with intracranial hemorrhage, papilledema, or high-output heart failure.
Findings:
- Twenty-one embolization procedures were performed using Onyx-18, platinum coils, and Embosphere microspheres.
- Arteriovenous malformations showed an average 60% size reduction; one vein of Galen malformation was completely embolized, and the other had a 50% flow reduction.
- Complications included transient monoparesis in one patient, and two patients died from intracranial hemorrhages post-procedure.
Implications:
- Onyx-18 demonstrates feasibility for embolizing pediatric intracranial vascular malformations.
- Long-term follow-up is crucial to establish the continued efficacy and safety of Onyx-18 in pediatric neurointerventional procedures.
Object:
Onyx-18 is a relatively new liquid embolic agent. The initial success with this polymer will result in increased utilization in children, but its use and safety in the pediatric population have not been firmly established.
Methods:
Between December 2005 and January 2008, the cerebral vascular malformations in 6 children were embolized using Onyx-18. The ages of the patients ranged from 1 day to 12 years. Pathological types of the vascular malformations included 4 arteriovenous malformations and 2 vein of Galen malformations. Clinical presentations included intracranial hemorrhage in 2 patients, papilledema in 1 patient, and high-output heart failure in 3 patients.
Results:
In 6 pediatric patients, 21 embolization procedures were performed utilizing a combination of Onyx-18, platinum coils, and Embosphere microspheres. The average estimated size reduction for the arteriovenous malformations was 60%. Total obliteration of a malformation was achieved in 1 patient. Two patients received adjuvant radiosurgery. Of the 2 vein of Galen malformations, one was completely embolized and the other had an approximately 50% reduction in flow. No open surgical intervention was used. Clinical follow-up ranged from 7 to 12 months. Angiographic follow-up data were obtained at 1, 6, and 7 months in 3 patients, whereas 1 patient awaits repeat angiography. Complications included a transient monoparesis with complete resolution in 1 patient. Two patients died within 24 hours of an embolization procedure due to intracranial hemorrhages.
Conclusions:
Onyx-18 is a feasible embolization agent for use in intracranial vascular malformations in the pediatric population, but long-term follow-up data will be necessary to assess the continued efficacy and safety of this agent.
