Impact of Onyx Embolization on Radiosurgical Management of Cerebral Arteriovenous Malformations: Treatment and Outcome

Ido Strauss*, Oz Haim, Daniel Umansky, Benjamin W. Corn, Vladimir Frolov, Natan Shtraus, Shimon Maimon, Andrew A. Kanner

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

7 Scopus citations

Abstract

Background Stereotactic radiosurgery (SRS) is a well-established treatment modality for cerebral arteriovenous malformations (AVMs). The main limiting factor in the radiosurgical treatment of AVMs is the volume of the nidus, with high-grade lesions often requiring combined treatment to reduce the SRS target volume. To overcome this limitation, we have been using a combined treatment approach consisting of endovascular embolization with Onyx followed by SRS. Objective To evaluate our clinical experience for safety and feasibility of this multimodality treatment approach. Methods This is a retrospective review of all adult patients with cerebral AVMs who received SRS treatment to their AVM after endovascular embolization with Onyx between June 2007 and June 2014. Results Thirty-five consecutive patients were identified. The mean follow-up period was 52.4 ± 22.6 months (range 18–97 months). We confirmed 18 (51.4%) complete nidus closures at a median time of 49.5 months (range 6.5–81 months) from SRS. High-resolution Magnetic resonance imaging/magnetic resonance angiography was performed routinely in all patients until closure of the nidus. Digital subtraction angiography was performed to confirm complete obliteration in 5 of the patients (28%); 13 patients are either planned for digital subtraction angiography or have refused it. In 6 patients (17%) a significant flow reduction was noted after a mean of 32 ± 16 months. No significant improvement was observed in 9 patients (26%) during the follow-up period. Two patients were lost to follow-up. Conclusions The multimodality treatment of cerebral AVMs using embolization with Onyx followed by SRS is feasible and safe. The use of Onyx significantly reduced the SRS treatment target volume.

Original languageEnglish
Pages (from-to)656-661
Number of pages6
JournalWorld Neurosurgery
Volume108
DOIs
StatePublished - Dec 2017

Keywords

  • AVM
  • Arteriovenous malformations
  • Embolization
  • Onyx
  • Radiosurgery
  • SRS

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