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Brain AVM Embolization with Onyx

W.J. van Rooija, M. Sluzewskia and G.N. Beuteb

a Department of Radiology, St. Elisabeth Ziekenhuis, Tilburg, The Netherlands
b Department of Neurosurgery and Radiosurgery, St. Elisabeth Ziekenhuis, Tilburg, The Netherlands


Figure 1
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  		Fig 1. A 44-year-old man with seizures and a left parietal AVM.

A, A 3.5-cm left parietal AVM with superficial and deep venous drainage (Spetzler and Martin grade IV).

B, The AVM shows 80% obliteration with a single Onyx injection of 4.8 mL in 64 minutes.

C, Onyx cast after embolization.

D, Complete obliteration of the AVM 2 years after gamma knife radiosurgery.


Figure 2
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  		Fig 2. A 28-year-old man with a 3-cm right parietooccipital AVM.

A, The AVM has 2 main feeders.

B, Complete obliteration of the AVM with 2 injections of Onyx (total of 3.5 mL).

C, Cast of Onyx.


Figure 3
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  		Fig 3. A 37-year-old woman with small high-flow AVM (pial fistula).

A, Large arteriovenous shunt from anterior cerebral artery.

B, Microcatheter just proximal to the shunt; from this point Onyx 34 was slowly injected.

C, Onyx cast after injecting 3.4 mL in 16 minutes.

D, Complete closure of the fistula at 6 weeks follow-up angiogram.


Figure 4
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  		Fig 4. Right temporal AVM in a 28-year-old woman with seizures. Complete occlusion occurred with a single 62-minute Onyx injection of 7.8 mL.

A, Oblique right internal carotid angiogram shows AVM fed by the anterior temporal artery and draining via a large superficial vein (white arrows) and a small superficial vein (black arrow).

B, Onyx cast after 12 minutes slow injection.

C, Onyx cast after 28 minutes.

D, Onyx cast after 62 minutes. The AVM is completely occluded, including the proximal parts of the draining veins (same arrows as in A).


Figure 5
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  		Fig 5. A 31-year-old man with seizures and right temporal AVM, embolized with Onyx.

A, Right temporal AVM with superficial venous drainage.

B, C, Small nidal remnant with open draining vein after subtotal obliteration.

D, Hemorrhage 3 days after embolization.

E, Angiogram after hemorrhage shows nidal remnant with no apparent venous drainage.

F, Angiogram after surgery demonstrates complete removal.





Copyright © 2008 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X