Onyx or combined with other embolic materials in the treatment of intracranial arteriovenous malformations

Objective To investigate the different treatment strategies,efficacy and complications in Onyx embolization of intracranial arteriovenous malformation(AVM).Methods A total of 183 patients with AVM were embolized with Onyx in Guangdong General Hospital from January 2009 to December 2011.Among the patients,Speztler-Martin(S-M) grade Ⅰ,Ⅱ,Ⅲ,Ⅳ,and Ⅴ were 28,53,54,31,and 17,respectively.Onyx embolization alone was 113;balloon-assisted embolization was 2;combined coil embolization was 5,and combined Glubran embolization was 63.The efficacy and complications of the patients were analyzed.Results ①Of the 183 patients,the complete thrombotic rate from S-M grade Ⅰ to Ⅱ were 68.0%,grade Ⅲ,Ⅳ,and Ⅴ were 14.8%,6.5%,and 0,respectively.The overall complete thrombotic rate was 35.5%.②The occurrence of complications: The intraoperative microcatheter broking off in 2 patients(1 of them was intraoperative catheter breaking),2 had postoperative bleeding(1 died),and 7 had new neurological deficits or original symptom deterioration.The overall incidence of complication rate was 6.6%.③143 patients were followed up for 1 to 18 months,among them 3 had rebleeding(2.1%,S-M grade Ⅰ to Ⅲ in each patient).Four patients healed completely after subtotal embolization,no recurrence or regeneration occurred.Of the 7 patients with newly developed neurological deficits or original symptom deterioration,6 recovered completely or the symptoms improved significantly at 3 to 6 months after the procedure,and 1 had no obvious improvement.Conclusion The individualized embolization of intracranial AVM with Onyx may reduce the endovascular treatment-related complications and improve the embolization effect.