Document Detail


Preoperative embolization of intracranial arteriovenous malformations with Onyx.
MedLine Citation:
PMID:  17762736     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Preoperative embolization in accordance with multimodal therapies for cerebral arteriovenous malformations (AVMs) is generally the first step in treatment and may result in complete obliteration. The Onyx liquid embolic system (Micro Therapeutics, Inc., Irvine, CA) may offer advantages for intranidal targeted embolization and microsurgical resection. We present our experience in the combined treatment of intracranial AVMs using Onyx embolization and neurosurgical resection. METHODS: We treated a total of 47 patients for compact intracranial AVMs that were located in the frontal or frontoparietal area (16 patients); temporal, temporoparietal, or temporo-occipital regions (12 patients); parietal or parieto-occipital areas (8 patients); occipital regions (8 patients); had basal ganglia involvement (2 patients); and was cerebellar (1 patient). The Spetzler-Martin grading scale values were as follows: 25 patients were Grades I or II, 10 patients were Grade III, and 12 patients were Grades IV or V. Twenty-three AVMs were located in eloquent brain regions. RESULTS: After we performed final embolizations, the mean nidus reduction was 84%. Seven patients had new, nondisabling neurological deficits, and four patients had new, disabling neurological deficits after embolization. Periprocedurally, five vessel perforations and four stuck microcatheters were encountered without clinical deficits. In two patients, delayed hemorrhage after embolization occurred with good clinical outcome. We completely resected 46 AVMs; in one patient, we detected an AVM on postoperative angiography. The mean operative time was 4.7 hours, and the mean blood loss was 455 mL. Clinical status worsened postoperatively in 14 patients. Angiographic and clinical follow-up examinations were available for 42 patients (89%); the average follow-up period was 13 months. We found no relapse of arteriovenous shunt. Fourteen patients improved clinically after discharge. Of the 42 patients followed up, 23 individuals had no neurological deficit, 16 had a nondisabling deficit, and three had a disabling deficit. CONCLUSION: Preoperative use of the Onyx liquid embolic system in cerebral AVM treatment allows profound occlusion by targeted embolization and provides a basis for safe neurosurgical resection.
Authors:
Werner Weber; Bernhard Kis; Ralf Siekmann; Paul Jans; Rudolf Laumer; Dietmar Kühne
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Publication Detail:
Type:  Clinical Trial; Journal Article    
Journal Detail:
Title:  Neurosurgery     Volume:  61     ISSN:  1524-4040     ISO Abbreviation:  Neurosurgery     Publication Date:  2007 Aug 
Date Detail:
Created Date:  2007-08-31     Completed Date:  2007-09-25     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7802914     Medline TA:  Neurosurgery     Country:  United States    
Other Details:
Languages:  eng     Pagination:  244-52; discussion 252-4     Citation Subset:  IM    
Affiliation:
Department of Radiology and Neuroradiology, Alfried Krupp Hospital, Essen, Germany.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Cerebral Angiography
Child
Combined Modality Therapy
Dimethyl Sulfoxide*
Embolization, Therapeutic / methods*
Female
Follow-Up Studies
Humans
Intracranial Arteriovenous Malformations / surgery*,  therapy*
Male
Middle Aged
Neurosurgical Procedures*
Polyvinyls*
Postoperative Complications / radiography
Preoperative Care
Treatment Outcome
Chemical
Reg. No./Substance:
0/Onyx copolymer; 0/Polyvinyls; 67-68-5/Dimethyl Sulfoxide

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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