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AJNR - American Journal of Neuroradiology

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Endovascular Treatment of Intracranial Arteriovenous Malformations with Onyx: Technical Aspects

W. Weber^a, B. Kis^b,c, R. Siekmann^d and D. Kuehne^a

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

View larger version (175K): [in this window] [in a new window]   Fig 1. A, Parietooccipital AVM after contrast injection of the guiding catheter. B, Selective perinidal catheter position. C, Contrast injection from this position in panel B. D, Onyx cast after embolization from position in panel B demonstrating that the Onyx cast has a greater volume than the AVM nidus contrasted with the selective injection.

View larger version (16K): [in this window] [in a new window]   Fig 2. Typical injection curve of one feeder treated with 4.77 mL Onyx (feeder 4 from Table 2) demonstrating the typical injection phases: A, first penetration (<400 seconds); B, cast time or precipitation time (400–700 seconds); and C, second penetration (>700 seconds).

View larger version (100K): [in this window] [in a new window]   Fig 3. Injection situations (feeder 4 from Table 2 and Fig 2) demonstrating the injection phases: primary penetration, and cast time where reflux begins until the secondary penetration.

View larger version (139K): [in this window] [in a new window]   Fig 4. Intranidal position of the microcatheter tip is marked by circle, arrows demonstrate the reflux distance, and final embolization result in an unsubtracted angiogram is shown at bottom right.