Abstract TP445: Combined Treatment of Brain Arteriovenous Malformations with Onyx Embolization followed by Radiosurgery
Purpose: The treatment of cerebral arteriovenous malformations (AVMs) is complex, based on embolization, surgery, and radiosurgery, or a combination of modalities. Treatment by Onyx embolization followed by radiosurgery was not previously evaluated. The goal of our study is to evaluate in an homogeneous, monocentric series the long-term clinical and anatomical outcome of patients treated by this combination.
Materials and Methods: From April 2003 to June 2008, 20 patients (11 females and 9 males, aged 10 to 55 years) were treated for a brain AVM by Onyx embolization followed by radiosurgery. AVM size was < 3cm in 7 cases and ≥ 3 cm in 13 cases. Modalities and complications of the procedure were analyzed as well as long term clinical and anatomical outcome (2-4 years after treatment).
Results: Out of 17 patients evaluated by DSA after radiosurgery, 10 had a complete occlusion of AVM nidus (58.8%). Complete occlusion was observed in 5/7 Spetzler-Martin grade 1-2 AVMs (71.4%) and in 5/10 Spetzler-Martin grade 3-4 AVM (50.0%). Complete occlusion was observed in 4/5 AVM with size < 3cm (80.0%) and 6/12 AVM with size > 3cm (50.0%). One out of 20 patients had significant worsening of their clinical status (mRS ≥ 2) at long term follow-up.
Conclusions: In this series of patients with AVMs treated with Onyx embolization followed by radiosurgery, the safety and efficacy of this treatment combination is quite satisfactory with a 58.8% rate of complete obliteration and a low rate of clinical complications (5.0%).
- © 2012 by American Heart Association, Inc.