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Combined Treatment of Brain AVMs with Use of Onyx Embolization followed by Radiosurgery

Combined Treatment of Brain AVMs with Use of Onyx Embolization followed by Radiosurgery BACKGROUND AND PURPOSE: The treatment of cerebral AVMs is complex, reliant on interventions such as embolization, surgery, and radiosurgery, or a combination of these modalities. To date, treatment with the embolic agent Onyx, followed by radiosurgery, has not been evaluated. The goal of this study was to evaluate the safety and efficacy of this combination in a homogeneous, monocentric series. MATERIALS AND METHODS: From April 2003 to June 2008, a total of 20 patients (11 women and 9 men; age range, 10–55 years) were treated for AVMs with Onyx embolization followed by radiosurgery. AVM sizes were <3 cm in 7 patients and ≥3 cm in 13 patients. Modalities and complications of the procedure were analyzed as well as the long-term clinical and anatomic outcomes (2–5 years after treatment). RESULTS: Of 17 patients evaluated by DSA after radiosurgery, 10 (58.8%) were observed to have complete occlusion of the AVM nidus. Complete occlusion was observed in 5 (71.4%) of 7 Spetzler-Martin grade I–II AVMs and in 5 (50.0%) of 10 Spetzler-Martin grade III–IV AVMs. Complete occlusion was observed in 4 (80.0%) of 5 AVMs of <3 cm and 6 (50.0%) of 12 AVMs of >3 cm. One of 20 patients had significant worsening of clinical status (mRS ≥2) at long-term follow-up. CONCLUSIONS: In this preliminary series, the safety and efficacy of combined treatment by Onyx embolization followed by radiosurgery are quite satisfactory, with a low rate of clinical complications (5.0%) and a 58.8% rate of complete obliteration of the AVM. ABBREVIATIONS: DMSO dimethyl-sulfoxide mRS modified Rankin Scale n -BCA n -butyl cyanoacrylate http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png American Journal of Neuroradiology American Journal of Neuroradiology

Combined Treatment of Brain AVMs with Use of Onyx Embolization followed by Radiosurgery

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Publisher
American Journal of Neuroradiology
Copyright
Copyright © 2013 by the American Society of Neuroradiology.
ISSN
0195-6108
eISSN
1936-959X
DOI
10.3174/ajnr.A3409
pmid
23391837
Publisher site
See Article on Publisher Site

Abstract

BACKGROUND AND PURPOSE: The treatment of cerebral AVMs is complex, reliant on interventions such as embolization, surgery, and radiosurgery, or a combination of these modalities. To date, treatment with the embolic agent Onyx, followed by radiosurgery, has not been evaluated. The goal of this study was to evaluate the safety and efficacy of this combination in a homogeneous, monocentric series. MATERIALS AND METHODS: From April 2003 to June 2008, a total of 20 patients (11 women and 9 men; age range, 10–55 years) were treated for AVMs with Onyx embolization followed by radiosurgery. AVM sizes were <3 cm in 7 patients and ≥3 cm in 13 patients. Modalities and complications of the procedure were analyzed as well as the long-term clinical and anatomic outcomes (2–5 years after treatment). RESULTS: Of 17 patients evaluated by DSA after radiosurgery, 10 (58.8%) were observed to have complete occlusion of the AVM nidus. Complete occlusion was observed in 5 (71.4%) of 7 Spetzler-Martin grade I–II AVMs and in 5 (50.0%) of 10 Spetzler-Martin grade III–IV AVMs. Complete occlusion was observed in 4 (80.0%) of 5 AVMs of <3 cm and 6 (50.0%) of 12 AVMs of >3 cm. One of 20 patients had significant worsening of clinical status (mRS ≥2) at long-term follow-up. CONCLUSIONS: In this preliminary series, the safety and efficacy of combined treatment by Onyx embolization followed by radiosurgery are quite satisfactory, with a low rate of clinical complications (5.0%) and a 58.8% rate of complete obliteration of the AVM. ABBREVIATIONS: DMSO dimethyl-sulfoxide mRS modified Rankin Scale n -BCA n -butyl cyanoacrylate

Journal

American Journal of NeuroradiologyAmerican Journal of Neuroradiology

Published: Jul 1, 2013

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