Onyx in brain arteriovenous malformation embolisation

Hilwati Hashim, A. Sobri Muda, Aida Abdul Aziz, Zuhanis Abdul Hamid

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Introduction: Embolisation has long been used as an adjunct to surgical resection in the treatment of brain arteriovenous malformation (bAVM). The most commonly used embolic material, n-butylcyanoacrylate glue, requires experience and skill to handle its quick and unpredictable flow and polymerisation. A new liquid embolic agent, ethylene vinyl alcohol copolymer (Onyx), is less adhesive and polymerises slowly, which provides better control for radiologists performing embolisation. Objective: To report our experience in embolisation using Onyx alone or in combination with histoacryl for bAVM embolisation in our tertiary referral centre. Methods: We retrospectively reviewed the anatomy, technical conditions, complications and clinical outcome of all bAVM patients embolised at our centre using Onyx alone or in combination with n-butylcyanoacrylate glue. Results: Between 2010 and 2013, 13 patients [6 (46.2%) male; 7 (53.8%) female; aged, 14– 57 years] were included, and a total of 31 embolisations were performed. Clinical presentation included hemorrhage [9 (69.2%)], seizures [2 (15.4%)], and headache [2 (15.4%)]. Most AVMs were located in the brain hemispheres [12 (92.3%)] and measured <3 cm [7 (53.8%]. Complete occlusion of the AVM was obtained in 2 (15.4%) patients; 11 (84.6%) patients had partial occlusion [6 (54.5%) had <50% nidus occlusion]. Complications occurred in four procedures involving 3 patients (morbidity, 23.1%). This resulted in the death of 1 patient (mortality, 7.7%) and complete recovery with no disability in 2 patients. Conclusion: The total nidal occlusion achieved herein is comparable to other similar studies. Our morbidity and mortality were higher compared to other studies which may be attributed to the small number of patients. More data is being collected which may better reflect on our experience.

Original languageEnglish
Pages (from-to)59-64
Number of pages6
JournalMalaysian Journal of Medical Sciences
Volume23
Issue number4
DOIs
Publication statusPublished - 1 Jul 2016

Fingerprint

Arteriovenous Malformations
Brain
Enbucrilate
Adhesives
Morbidity
Mortality
Tertiary Care Centers
Polymerization
Headache
Anatomy
Seizures
Hemorrhage

Keywords

  • Angiography
  • Arteriovenous malformations
  • Butylcyanoacrylate
  • Onyx copolymer
  • Therapeutic embolisation

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Onyx in brain arteriovenous malformation embolisation. / Hashim, Hilwati; Muda, A. Sobri; Abdul Aziz, Aida; Abdul Hamid, Zuhanis.

In: Malaysian Journal of Medical Sciences, Vol. 23, No. 4, 01.07.2016, p. 59-64.

Research output: Contribution to journalArticle

Hashim, H, Muda, AS, Abdul Aziz, A & Abdul Hamid, Z 2016, 'Onyx in brain arteriovenous malformation embolisation', Malaysian Journal of Medical Sciences, vol. 23, no. 4, pp. 59-64. https://doi.org/10.21315/mjms2016.23.4.8
Hashim, Hilwati ; Muda, A. Sobri ; Abdul Aziz, Aida ; Abdul Hamid, Zuhanis. / Onyx in brain arteriovenous malformation embolisation. In: Malaysian Journal of Medical Sciences. 2016 ; Vol. 23, No. 4. pp. 59-64.
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AB - Introduction: Embolisation has long been used as an adjunct to surgical resection in the treatment of brain arteriovenous malformation (bAVM). The most commonly used embolic material, n-butylcyanoacrylate glue, requires experience and skill to handle its quick and unpredictable flow and polymerisation. A new liquid embolic agent, ethylene vinyl alcohol copolymer (Onyx), is less adhesive and polymerises slowly, which provides better control for radiologists performing embolisation. Objective: To report our experience in embolisation using Onyx alone or in combination with histoacryl for bAVM embolisation in our tertiary referral centre. Methods: We retrospectively reviewed the anatomy, technical conditions, complications and clinical outcome of all bAVM patients embolised at our centre using Onyx alone or in combination with n-butylcyanoacrylate glue. Results: Between 2010 and 2013, 13 patients [6 (46.2%) male; 7 (53.8%) female; aged, 14– 57 years] were included, and a total of 31 embolisations were performed. Clinical presentation included hemorrhage [9 (69.2%)], seizures [2 (15.4%)], and headache [2 (15.4%)]. Most AVMs were located in the brain hemispheres [12 (92.3%)] and measured <3 cm [7 (53.8%]. Complete occlusion of the AVM was obtained in 2 (15.4%) patients; 11 (84.6%) patients had partial occlusion [6 (54.5%) had <50% nidus occlusion]. Complications occurred in four procedures involving 3 patients (morbidity, 23.1%). This resulted in the death of 1 patient (mortality, 7.7%) and complete recovery with no disability in 2 patients. Conclusion: The total nidal occlusion achieved herein is comparable to other similar studies. Our morbidity and mortality were higher compared to other studies which may be attributed to the small number of patients. More data is being collected which may better reflect on our experience.

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KW - Onyx copolymer

KW - Therapeutic embolisation

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