Treatment of cerebral arteriovenous malformations with Onyx

Objective To discuss the techniques and efficacy of embolization in treating cerebral arteriovenous malformations (AVMs) using a new liquid embolic agent (Onyx) . Methods 6 F sheath was inserted into femoral artery, then 6 F guiding catheter was introduced into the internal carotid artery or vertebral artery, Ultraflow microcatheter was navigated into the nidus of AVMs, Onyx-18 was injected into the nidus of cerebral AVM slowly using the plug and push technique . 13 cases of cerebral AVMs were located in functional area, 6 cases in deep cerebral area, and 2 cases in cerebellar hemisphere. The diameter of AVMs was about 3cm in 9 cases, 3 - 6cm in 8 cases, and larger than 6cm in 4 cases. Results 20% -100% embolization was achieved in all cases, 40% in early stage of treatment, and nearly 80% at present. In the initial stage, there was severe cerebral bleeding induced by microcatheter withdrew in 2 cases because of the lack of enough experience. and underwent surgical treatment. However, the other 19 AVM cases with Onyx embolization were treated successfully without severe complications. Conclusion Onyx has unique and distinctive superiority in treating cerebral AVMs with large size and located in deep or functional areas. However, the long-term efficacy of Onyx embolization needs to be followed up.