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Updated: May 24, 2026
Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Curative embolization of brain arteriovenous malformations with onyx: patient selection, embolization technique, and
W J van Rooij1, S Jacobs, M Sluzewski
1Department of Radiology, St. Elisabeth Ziekenhuis, Tilburg, the Netherlands. wjjvanrooij@gmail.com
Background And Purpose:
A new curative embolization technique with Onyx for selected small and medium-sized superficially located brain AVMs was developed, which consists of obliteration of the nidus, including incremental occlusion of the draining veins. We report our first clinical results.
Materials And Methods:
Between June 2008 and July 2011, 24 patients (7 women, 17 men; mean age, 41 years; range, 6-74 years) with AVMs were selected for curative embolization with Onyx. Presentation was hemorrhage in 14 and seizures in 10 patients. AVM location was frontal in 11, occipital in 6, parietal in 4, and temporal in 3. AVM size was a mean of 2.2 cm (median, 2; range, 1-3 cm).
Results:
Complete angiographic obliteration of the AVM with Onyx in a single session was achieved in all 24 patients. There were no hemorrhagic or ischemic complications (0%; 95% CI, 0%-16.3%), and no new deficits induced by the treatment. Of 14 patients with ruptured AVMs, 1 patient who presented with a large frontal hematoma died shortly after surgical evacuation of the hematoma following complete embolization of a micro-AVM. Follow-up angiography at 3 months in 23 patients demonstrated a small AVM remnant in 1 that was treated with gamma knife radiosurgery. The other 22 AVMs remained completely occluded.
Conclusions:
In selected patients with small and medium-sized superficial brain AVMs, as defined in our study, injection of Onyx by using a curative embolization technique in a single session seems to provide a safe and effective alternative to radiosurgery or surgery.
Insights
A new Onyx embolization technique offers a safe and effective single-session treatment for select brain arteriovenous malformations (AVMs). This curative embolization method achieved complete obliteration in all patients, with no complications.
Area of Science:
- Interventional Neuroradiology
- Vascular Neurology
- Neurosurgery
Background:
- Brain arteriovenous malformations (AVMs) pose significant risks, including hemorrhage and neurological deficits.
- Traditional treatments like surgery and radiosurgery have limitations for certain AVM types.
Purpose of the Study:
- To evaluate a novel curative embolization technique using Onyx for small to medium-sized, superficially located brain AVMs.
- To report the initial clinical outcomes of this new embolization strategy.
Main Methods:
- Twenty-four patients with brain AVMs underwent curative embolization with Onyx between June 2008 and July 2011.
- The technique involved obliteration of the nidus and incremental occlusion of draining veins in a single session.
- Patient demographics, AVM characteristics, and clinical presentations were recorded.
Main Results:
- Complete angiographic obliteration of AVMs was achieved in all 24 patients during the initial session.
- No hemorrhagic or ischemic complications were observed.
- Follow-up angiography confirmed sustained occlusion in 22 of 23 patients, with one requiring radiosurgery for a remnant.
Conclusions:
- This Onyx embolization technique provides a safe and effective single-session alternative for selected patients with small to medium-sized superficial brain AVMs.
- The results suggest this method is a viable option compared to radiosurgery or surgery.
- Further studies are warranted to confirm long-term efficacy and safety profiles.
