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AJNR - American Journal of Neuroradiology

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Treatment and Follow-Up of 22 Unruptured Wide-Necked Intracranial Aneurysms of the Internal Carotid Artery with Onyx HD 500

Werner Weber^a, Ralf Siekmann^d, Bernhard Kis^b and Dietmar Kuehne^c

^a Department of Radiology and Neuroradiology, Alfried Krupp Hospital, Giessen, Germany
^b Department of Neurology and Clinical Neurophysiology, Alfried Krupp Hospital, Giessen, Germany
^c Department of Psychiatry and Psychotherapy University of Duisburg-Essen, Essen, Germany
^d Department of Neuroradiology, Justus Liebig University Hospital, Giessen, Germany

View larger version (96K): [in a new window]   FIG 1. A 61-year-old male patient presented with an asymptomatic bilobulated aneurysm with a common neck of both sacks (A). Complete occlusion in 7 injection cycles to demonstrate the filling of an aneurysm with Onyx (B–G). Angiography demonstrated a stable result 12 months after the treatment (H).

View larger version (56K): [in a new window]   FIG 2. A 35-year-old female patient with GDC treatment in 1994; regrowth of the aneurysm; the patient was blind on the ipsilateral eye since GDC treatment, so there was no need to protect the ophthalmic artery; origin of the ophthalmic artery at the neck of the aneurysm (A, ring). Complete occlusion of the aneurysm after treatment with Onyx (B). Road map and CT demonstrated migration of Onyx in the proximal part of the ophthalmic artery (C and D, ring).

View larger version (60K): [in a new window]   FIG 3. A 58-year-old female patient years after GDC treatment and regrowth of the partially thrombosed aneurysm (A). Biplanar angiography demonstrated complete occlusion of the aneurysm after treatment with Onyx (B and C). CT after the treatment demonstrated the migration of Onyx in the parent artery forming a thin layer on the inner surface of the right internal carotid artery (D, ring)

View larger version (133K): [in a new window]   FIG 4. A 60-year-old female patient with an asymptomatic ophthalmic aneurysm (A). Complete occlusion of the aneurysm post Onyx (B). Bulging of the balloon into the aneurysm neck during the injection of Onyx (C). Follow-up angiography 5 months after the treatment demonstrated complete occlusion of the aneurysm, reconstruction of the parent artery, and "healing reaction" at the neck (D and E, arrow).