title: Endovascular treatment of unruptured and ruptured brain arteriovenous malformations with Onyx18: a monocentric series of 84 patients.
abstract: BACKGROUND
  Brain arteriovenous malformations (AVMs) are a rare pathology, and their treatment is discussed. The development of techniques and materials in endovascular, radiosurgical, and neurosurgical fields led to higher rates of complete occlusions and good clinical outcomes.
  
  
  METHODS
  84 patients (52 men, 32 women; mean age 38.2 years; range, 9-70 years) were treated at our institution with Onyx18 from 2001 to 2011. Patients treated with other embolic agents, with micro-AVMs, were not included in the analysis.
  
  
  RESULTS
  Complete occlusion was achieved in 27/84 patients (32.2%), in 40/84 (47.6%) brain AVMs occlusion of 80-90% of the nidus was obtained, and in 17/84 (20.3%) cases <80% of the nidus was occluded. Intraprocedural adverse events occurred in 11/84 patients (13.1%), and overall mortality and disabling permanent morbidity were 2.3% (2/84) and 4.7% (4/84), respectively.
  
  
  CONCLUSIONS
  Endovascular treatment may be considered a safe and effective approach in superficial small brain AVMs in addition to surgery, mostly in ruptured AVMs. The therapeutic strategy should be to cure small and medium AVMs with endovascular treatment alone or combined treatment. Large unruptured AVMs (Spetzler-Martin grades IV-V) should be treated with target embolization of high flow fistulas or intranidal aneurysms.
authors.affiliation: Interventional Neuroradiology Unit, Careggi University Hospital, Florence, Italy.
authors.forename: Arturo
authors.initials: A
authors.lastname: Consoli
authors.affiliation: Department of Radiology, Careggi University Hospital, Florence, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Scarpini
authors.affiliation: Department of Radiology, Careggi University Hospital, Florence, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Rosi
authors.affiliation: Interventional Neuroradiology Unit, Careggi University Hospital, Florence, Italy.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Renieri
authors.affiliation: Department of Radiology, Careggi University Hospital, Florence, Italy.
authors.forename: Ivano
authors.initials: I
authors.lastname: Chiarotti
authors.affiliation: Department of Radiology, Careggi University Hospital, Florence, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Vignoli
authors.affiliation: Department of Radiology, Careggi University Hospital, Florence, Italy.
authors.forename: Iacopo
authors.initials: I
authors.lastname: Ciampa
authors.affiliation: Interventional Neuroradiology Unit, Careggi University Hospital, Florence, Italy.
authors.forename: Sergio
authors.initials: S
authors.lastname: Nappini
authors.affiliation: Interventional Neuroradiology Unit, Careggi University Hospital, Florence, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Limbucci
authors.affiliation: Interventional Neuroradiology Unit, Careggi University Hospital, Florence, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Mangiafico
mesh_terms: D000328:Adult; D000368:Aged; D002648:Child; D004338:Drug Combinations; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000379:methods*; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011145:Polyvinyls / Q000627:therapeutic use*; D013635:Tantalum / Q000627:therapeutic use*; D016896:Treatment Outcome; D062666:Vascular Access Devices
chemical_list: D004338:Drug Combinations; C558446:Onyx 18; D011145:Polyvinyls; D013635:Tantalum
keywords: Arteriovenous Malformation; Hemorrhage; Intervention; Vascular Malformation