Onyx in Brain Arteriovenous Malformation Embolisation|
Hashim, Hilwati; Muda, A. Sobri; Abdul Aziz, Aida & Abdul Hamid, Zuhanis
Introduction: 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.
Conclusion: 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.
therapeutic embolisation; arteriovenous malformations; angiography; butylcyanoacrylate; Onyx copolymer