title: Onyx in Brain Arteriovenous Malformation Embolisation.
abstract: BACKGROUND
  Embolisation has long been used as an adjunct to surgical resection in the treatment of brain arteriovenous malformation (bAVM). The most commonly used embolic material, n-butylcyanoacrylate glue, requires experience and skill to handle its quick and unpredictable flow and polymerisation. A new liquid embolic agent, ethylene vinyl alcohol copolymer (Onyx), is less adhesive and polymerises slowly, which provides better control for radiologists performing embolisation.
  
  
  OBJECTIVE
  To report our experience in embolisation using Onyx alone or in combination with histoacryl for bAVM embolisation in our tertiary referral centre.
  
  
  METHODS
  We retrospectively reviewed the anatomy, technical conditions, complications and clinical outcome of all bAVM patients embolised at our centre using Onyx alone or in combination with n-butylcyanoacrylate glue.
  
  
  RESULTS
  Between 2010 and 2013, 13 patients [6 (46.2%) male; 7 (53.8%) female; aged, 14-57 years] were included, and a total of 31 embolisations were performed. Clinical presentation included hemorrhage [9 (69.2%)], seizures [2 (15.4%)], and headache [2 (15.4%)]. Most AVMs were located in the brain hemispheres [12 (92.3%)] and measured <3 cm [7 (53.8%]. Complete occlusion of the AVM was obtained in 2 (15.4%) patients; 11 (84.6%) patients had partial occlusion [6 (54.5%) had <50% nidus occlusion]. Complications occurred in four procedures involving 3 patients (morbidity, 23.1%). This resulted in the death of 1 patient (mortality, 7.7%) and complete recovery with no disability in 2 patients.
  
  
  CONCLUSIONS
  The total nidal occlusion achieved herein is comparable to other similar studies. Our morbidity and mortality were higher compared to other studies which may be attributed to the small number of patients. More data is being collected which may better reflect on our experience.
authors.affiliation: Imaging Unit, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, Jalan Hospital, 47000 Sungai Buloh, Selangor, Malaysia.
authors.forename: Hilwati
authors.initials: H
authors.lastname: Hashim
authors.affiliation: Department of Radiology, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Cheras, Wilayah Persekutuan Kuala Lumpur, Malaysia.
authors.forename: A Sobri
authors.initials: AS
authors.lastname: Muda
authors.affiliation: Department of Radiology, Hospital Sungai Buloh, Jalan Hospital, 47000 Sungai Buloh, Selangor, Malaysia.
authors.forename: Aida
authors.initials: A
authors.lastname: Abdul Aziz
authors.affiliation: Department of Radiology, Institut Kanser Negara, Jalan P7, Presint 7, 62250 Putrajaya, Malaysia.
authors.forename: Zuhanis
authors.initials: Z
authors.lastname: Abdul Hamid
keywords: Onyx copolymer; angiography; arteriovenous malformations; butylcyanoacrylate; therapeutic embolisation