title: Combined treatment of brain AVMs with use of Onyx embolization followed by radiosurgery.
abstract: OBJECTIVE
  The treatment of cerebral AVMs is complex, reliant on interventions such as embolization, surgery, and radiosurgery, or a combination of these modalities. To date, treatment with the embolic agent Onyx, followed by radiosurgery, has not been evaluated. The goal of this study was to evaluate the safety and efficacy of this combination in a homogeneous, monocentric series.
  
  
  METHODS
  From April 2003 to June 2008, a total of 20 patients (11 women and 9 men; age range, 10-55 years) were treated for AVMs with Onyx embolization followed by radiosurgery. AVM sizes were <3 cm in 7 patients and ≥3 cm in 13 patients. Modalities and complications of the procedure were analyzed as well as the long-term clinical and anatomic outcomes (2-5 years after treatment).
  
  
  RESULTS
  Of 17 patients evaluated by DSA after radiosurgery, 10 (58.8%) were observed to have complete occlusion of the AVM nidus. Complete occlusion was observed in 5 (71.4%) of 7 Spetzler-Martin grade I-II AVMs and in 5 (50.0%) of 10 Spetzler-Martin grade III-IV AVMs. Complete occlusion was observed in 4 (80.0%) of 5 AVMs of <3 cm and 6 (50.0%) of 12 AVMs of >3 cm. One of 20 patients had significant worsening of clinical status (mRS ≥2) at long-term follow-up.
  
  
  CONCLUSIONS
  In this preliminary series, the safety and efficacy of combined treatment by Onyx embolization followed by radiosurgery are quite satisfactory, with a low rate of clinical complications (5.0%) and a 58.8% rate of complete obliteration of the AVM.
authors: Departments of Neuroradiology, Hôpital Maison-Blanche, CHU Reims, Reims, France. lpierot@gmail.com
authors: L
authors: L
authors: Pierot
authors: K
authors: K
authors: Kadziolka
authors: F
authors: F
authors: Litré
authors: P
authors: P
authors: Rousseaux
mesh_terms: D000293:Adolescent; D000328:Adult; D015901:Angiography, Digital Subtraction / Q000379:methods; D001037:Aphasia / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D004121:Dimethyl Sulfoxide / Q000627:therapeutic use*; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D004659:Enbucrilate / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000145:classification / Q000601:surgery / Q000628:therapy*; D007431:Intraoperative Complications; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010291:Paresis / Q000209:etiology; D011145:Polyvinyls / Q000627:therapeutic use*; D011183:Postoperative Complications; D011446:Prospective Studies; D016634:Radiosurgery / Q000009:adverse effects / Q000379:methods*; D012422:Rupture, Spontaneous; D012449:Safety; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: C450660:Onyx copolymer; D011145:Polyvinyls; D004659:Enbucrilate; D004121:Dimethyl Sulfoxide
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