Supratentorial Brain AVM Embolization with Onyx-18 and Post-Embolization Management. A Single-Center Experience

Area of Science:

• Endovascular Therapy
• Neurosurgery
• Radiology

Background:

• Onyx is increasingly utilized for endovascular treatment of intracranial arteriovenous malformations (AVMs).
• Optimal embolic effect and post-embolization management strategies for Onyx remain subjects of ongoing discussion.
• Supratentorial brain arteriovenous malformations (SBAVMs) present unique therapeutic challenges.

Purpose of the Study:

• To report institutional experience using Onyx for SBAVM treatment.
• To discuss and propose post-embolization management protocols based on obliteration outcomes.
• To evaluate the efficacy and safety of Onyx in SBAVM embolization.

Main Methods:

• Retrospective analysis of 20 patients with SBAVMs treated with Onyx embolization from June 2006 to July 2008.
• Patients underwent subsequent treatments including angiography, stereotactic radiosurgery, or microsurgery based on embolization results.
• Data collected included patient demographics, presenting symptoms, Onyx volume used, and obliteration degree.

Main Results:

• Complete obliteration (>95%) achieved in 35% (7/20) of patients.
• Subtotal obliteration (>80%) in 20% (4/20) and partial obliteration (20-80%) in 45% (9/20) of patients.
• Average Onyx volume used was 2.2 ml, with an average AVM volume reduction of 80%.

Conclusions:

• Onyx demonstrates suitable diffuse and controllable properties for SBAVM embolization.
• Suggested management includes clinical follow-up for complete obliteration, radiosurgery/angiography for subtotal, and surgery for partial obliteration.
• Long-term follow-up studies are necessary to fully ascertain the prognosis of proposed post-embolization management strategies.