title: Curative embolization of brain arteriovenous malformations with onyx: patient selection, embolization technique, and results.
abstract: OBJECTIVE
  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.
  
  
  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.
authors.affiliation: Department of Radiology, St. Elisabeth Ziekenhuis, Tilburg, the Netherlands. wjjvanrooij@gmail.com
authors.forename: W J
authors.initials: WJ
authors.lastname: van Rooij
authors.forename: S
authors.initials: S
authors.lastname: Jacobs
authors.forename: M
authors.initials: M
authors.lastname: Sluzewski
authors.forename: B
authors.initials: B
authors.lastname: van der Pol
authors.forename: G N
authors.initials: GN
authors.lastname: Beute
authors.forename: M E
authors.initials: ME
authors.lastname: Sprengers
mesh_terms: D000293:Adolescent; D000368:Aged; D002648:Child; D004121:Dimethyl Sulfoxide / Q000627:therapeutic use*; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006490:Hemostatics / Q000627:therapeutic use; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000000981:diagnostic imaging* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011145:Polyvinyls / Q000627:therapeutic use*; D011859:Radiography; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D006490:Hemostatics; C450660:Onyx copolymer; D011145:Polyvinyls; D004121:Dimethyl Sulfoxide