title: Supratentorial Brain AVM Embolization with Onyx-18 and Post-Embolization Management. A Single-Center Experience.
abstract: Onyx is increasingly used in endovascular therapy of intracranial arteriovenous malformations (AVMs). However, the embolic effect and post-embolization management are still under discussion. We report our experience in the treatment of supratentorial brain arteriovenous malformations (SBAVMs) with Onyx and discuss post-embolic management. From June 2006 to July 2008, 20 patients with SBAVM were embolized with Onyx. There were 14 men and six women ranging from 14 to 64 years of age (mean 38.3 years). Initial symptoms included spontaneous hemorrhage (n=12), headaches (n=4), seizure (n=3) and incidentally disclosed after head trauma (n=1). After the endovascular procedure, all had subsequent treatment (follow-up angiogram, stereotactic radiosurgery or microsurgery) according to the obliteration degree. At angiography, seven patients (35%, 7/20) were completely obliterated (over 95% closure) after embolization while one suffered a small subarachnoid hemorrhage without permanent clinical sequelae. Four patients (20%, 4/20) were subtotally obliterated (over 80% closure), one patient who suffered severe cerebral edema after embolization underwent decompressive craniectomy, two patients had additional radiosurgery and one patient had follow-up angiogram. Nine patients (45%, 9/20) were partially obliterated (20-80% closure), five patients had additional surgery, two patients had additional radiosurgery and two patients had follow-up angiogram (one patient had intraventricular hemorrhage three months after embolization). Of all 20 AVMs, an average of 2.2 ml Onyx was used per patient and average volume reduction was 80% (range, 30%-99%). Onyx is suitable for embolization of SBAVMs because of its diffuse controllable properties. We suggest clinical follow-up after complete obliteration, additional radiosurgery or angiographic follow-up after subtotal obliteration and additional surgery after partially obliteration. More cases with long-term follow-up are needed to evaluate the long-term prognosis of our post-embolization management.
authors.affiliation: Department of Neurosurgery, First Affiliated Hospital, College of Medicine, Zhejiang University; Hangzhou, China - ZRY1960@gmail.com or zhou-hj@163.com.
authors.forename: J W
authors.initials: JW
authors.lastname: Pan
authors.forename: H J
authors.initials: HJ
authors.lastname: Zhou
authors.forename: R Y
authors.initials: RY
authors.lastname: Zhan
authors.forename: S
authors.initials: S
authors.lastname: Wan
authors.forename: M
authors.initials: M
authors.lastname: Yan
authors.forename: W J
authors.initials: WJ
authors.lastname: Fan
authors.forename: Z X
authors.initials: ZX
authors.lastname: Wu
authors.forename: S S
authors.initials: SS
authors.lastname: Zheng
references.citation: Neurosurgery. 2008 Jun;62(6):1213-25; discussion 1225-6
references.pmid: 18824988
references.citation: AJNR Am J Neuroradiol. 2009 Jan;30(1):99-106
references.pmid: 18842759
references.citation: AJNR Am J Neuroradiol. 2007 Jan;28(1):172-7; discussion 178
references.pmid: 17213451
references.citation: AJNR Am J Neuroradiol. 2007 Feb;28(2):371-7
references.pmid: 17297015
references.citation: Interv Neuroradiol. 2005 Oct 5;11(Suppl 1):159-64
references.pmid: 20584470
references.citation: Neurosurgery. 2001 May;48(5):984-95; discussion 995-7
references.pmid: 11334300
references.citation: Neuroradiology. 2008 Jul;50(7):589-97
references.pmid: 18408923
references.citation: Zhonghua Wai Ke Za Zhi. 2007 Feb 15;45(4):223-5
references.pmid: 17502012
references.citation: J Neurosurg. 2003 Feb;98(2):366-70
references.pmid: 12593624
references.citation: Interv Neuroradiol. 2005 Oct 5;11(Suppl 1):141-57
references.pmid: 20584469
references.citation: Neurosurgery. 2007 Aug;61(2):244-52; discussion 252-4
references.pmid: 17762736
references.citation: Neurosurgery. 1998 Nov;43(5):1164-75
references.pmid: 9802860
references.citation: Clin Neuropathol. 2002 Jan-Feb;21(1):13-7
references.pmid: 11846039
references.citation: AJNR Am J Neuroradiol. 2004 Aug;25(7):1139-43
references.pmid: 15313697