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Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
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Comment on: Curative Embolization of Brain Arteriovenous Malformations with Onyx: Patient Selection, Embolization
M Möhlenbruch1, M Bendszus, S Rohde
1Abteilung fuer Neuroradiologie, Neurologische Klinik, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany.
Background And Purpose:
A new curative embolization technique with Onyx for selected small- and medium-sized superficially located brain arteriovenous malformations (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 six, parietal in four, and temporal in three. 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, one 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 one 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 safely and effectively treats selected brain arteriovenous malformations (AVMs) in a single session. This method obliterates the AVM nidus and draining veins, offering an alternative to surgery or radiosurgery.
Area of Science:
- Interventional Neuroradiology
- Vascular Neurology
- Neurosurgery
Background:
- Brain arteriovenous malformations (AVMs) are complex vascular lesions.
- Traditional treatments include surgery and radiosurgery, each with limitations.
- A novel curative embolization technique using Onyx has been developed.
Purpose of the Study:
- To evaluate the clinical outcomes of a new curative embolization technique for brain AVMs.
- To assess the safety and efficacy of Onyx injection for AVM obliteration.
Main Methods:
- Twenty-four patients with small- to medium-sized superficial brain AVMs were treated between June 2008 and July 2011.
- The technique involved obliteration of the AVM nidus and incremental occlusion of draining veins using Onyx.
- Patient demographics, AVM characteristics, and clinical presentations (hemorrhage or seizures) were recorded.
Main Results:
- Complete angiographic obliteration of AVMs was achieved in all 24 patients in a single session.
- No hemorrhagic or ischemic complications occurred (0%); no new treatment-induced deficits were observed.
- Follow-up angiography confirmed sustained occlusion in 22 of 23 patients, with one requiring radiosurgery.
Conclusions:
- This Onyx embolization technique is a safe and effective single-session treatment for selected small- to medium-sized superficial brain AVMs.
- It presents a viable alternative to conventional treatments like radiosurgery and surgery.
- Further research may expand its application in neurovascular interventions.
