title: Curative embolization of pediatric intracranial arteriovenous malformations using Onyx: the role of new embolization techniques on patient outcomes.
abstract: BACKGROUND
  Intracranial arteriovenous malformations (AVMs) are the most frequent cause of hemorrhagic strokes in the pediatric population. The study aim was to retrospectively assess the safety and efficacy of Onyx embolization with the intention to cure AVMs in a pediatric population.
  
  
  METHODS
  A retrospective analysis of all patients (<18 years) who underwent endovascular embolization using Onyx at our institution was conducted. The primary endpoint was the composite complete angiographic occlusion of AVM immediately after the last embolization session that had no procedure-related complication requiring emergency surgery. Secondary endpoints were angiographic occlusion rates, procedure-related complications, and clinical outcomes after treatment and at the 6-month follow-up
  
  
  RESULTS
  Twenty-three patients (mean age, 11.7 years) underwent a total of 45 embolization sessions. The median Spetzler-Martin grade was 3 (range 1 to 4). The primary endpoint was achieved in 19 patients (82.6 %). Complete angiographic occlusion of the AVM was obtained in 21 patients (91.3 %) immediately after embolization and at the 6-month follow-up. Embolization-related complications were observed in three patients (13 %). None of the complications resulted in permanent functional disability or death. In two patients (8.7 %), the AVM could not be completely occluded by embolization alone and the patients were referred to radiosurgery and microsurgery, respectively.
  
  
  CONCLUSIONS
  Onyx embolization of AVM in pediatric patients with the intention to cure resulted in high occlusion rates without increasing neurological disability or death. The development of new embolization techniques and devices seems to improve the safety of Onyx embolization.
authors.affiliation: Division of Interventional Neuroradiology, Medical School of Ribeirão Preto, University of São Paulo, Avenida Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, SP, Brazil, 14048-090.
authors.forename: L H
authors.initials: LH
authors.lastname: de Castro-Afonso
authors.affiliation: Division of Interventional Neuroradiology, Medical School of Ribeirão Preto, University of São Paulo, Avenida Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, SP, Brazil, 14048-090.
authors.forename: G S
authors.initials: GS
authors.lastname: Nakiri
authors.affiliation: Division of Pediatric Neurosurgery, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil.
authors.forename: R S
authors.initials: RS
authors.lastname: Oliveira
authors.affiliation: Division of Pediatric Neurosurgery, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil.
authors.forename: M V
authors.initials: MV
authors.lastname: Santos
authors.affiliation: Division of Pediatric Neurosurgery, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil.
authors.forename: A C Dos
authors.initials: ACD
authors.lastname: Santos
authors.affiliation: Division of Diagnostic Neuroradiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil.
authors.forename: H R
authors.initials: HR
authors.lastname: Machado
authors.affiliation: Division of Interventional Neuroradiology, Medical School of Ribeirão Preto, University of São Paulo, Avenida Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, SP, Brazil, 14048-090. dgabud@fmrp.usp.br.
authors.forename: D G
authors.initials: DG
authors.lastname: Abud
mesh_terms: D000293:Adolescent; D002533:Cerebral Angiography / Q000379:methods; D002648:Child; D002675:Child, Preschool; D000072226:Computed Tomography Angiography / Q000379:methods; D004121:Dimethyl Sulfoxide / Q000009:adverse effects / Q000627:therapeutic use*; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006490:Hemostatics / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007223:Infant; D002538:Intracranial Arteriovenous Malformations / Q000000981:diagnostic imaging* / Q000628:therapy*; D008297:Male; D011145:Polyvinyls / Q000009:adverse effects / Q000627:therapeutic use*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D006490:Hemostatics; C450660:Onyx copolymer; D011145:Polyvinyls; D004121:Dimethyl Sulfoxide
keywords: Brain arteriovenous malformations; Children; Endovascular embolization; Intracranial arteriovenous malformations; Pediatric