Endovascular treatment of intracranial arteriovenous malformations using ONYX

Abstract

The brain arteriovenous malformation (AVM) is an abnormal connection between arteries and veins of the brain, bypassing the capillary system. Endovascular embolization was performed in thirty-two patients with cerebral AVMs. The objective of endovascular AVM treatment is set for each patient upon consultations with a radiologist and a neurosurgeon. In most cases, the disorder is asymptomatic. We report our initial experiences in the treatment of brain AVMs with Onyx embolization. Methods Between January 2015 and December 2015, 32 patients with brain AVMs were embolized with Onyx. Clinical presentation included incidental finding in 2 patients, neurologic deficits in 1 patient, headaches in 7 patients, seizures in 9 patients and intracerebral haemorrhage in 12 patients. According to the Spetzler-Martin scale, one AVMs was grade I, 5 were grade II, 17 were grade III, 7 were grade IV, and 2 were grade V. Twenty-eight (86%) AVMs were located in eloquent regions. Initial complete obliteration after final embolization was achieved in 7 patients (20.2%), with an average of 85.5% (range, 30-100%) volume reduction. One-year follow-up angiography was performed on 11 (34.8%) patients. Conclusions Endovascular treatment of cerebral AVMs with super selective embolization with ONYX is a safe and effective alternative treatment paths next to microsurgery.