Impact of Pre-operative Embolization With Onyx for Brain Arteriovenous Malformation Surgery

• Published in: Frontiers in neurology 2022-04, Vol.13, p.875260-875260
• Main Authors: Izumo, Tsuyoshi, Okamura, Kazuaki, Takahira, Ryotaro, Matsunaga, Yuki, Sadakata, Eisaku, Maeda, Hajime, Yamaguchi, Susumu, Baba, Shiro, Morofuji, Yoichi, Hiu, Takeshi, Horie, Nobutaka, Anda, Takeo, Kitagawa, Naoki, Tokunaga, Yoshiharu, Hayashi, Kentaro, Matsumoto, Yasushi, Nagata, Izumi, Matsuo, Takayuki
• Format: Article
• Language: English
• Subjects: cerebral arteriovenous malformation (cAVM); coils; N-butyl cyanoacrylate; Neurology; neurosurgery; Onyx
• ISSN: 1664-2295; 1664-2295
• DOI: 10.3389/fneur.2022.875260

To clarify the safety and efficacy of pre-operative embolization using Onyx liquid embolic agent (Onyx; ev3) compared with -butyl cyanoacrylate (NBCA; Cordis Neurovascular, Inc.) or coils in cerebral arteriovenous malformation (AVM) surgery. This was a retrospective review of a prospectively collected clinical database of brain AVMs treated at our institute from January 2005 to March 2021. A total of 38 consecutive patients who underwent AVM resection after pre-operative embolization were included. Based on pre-operative embolization materials, the patients were divided into the pre-Onyx group ( = 16), in which NBCA or coils were used for embolization, and the Onyx group ( = 22). Patient characteristics and treatment results were compared between the two groups. Patient characteristics were comparable between the two groups in terms of age, sex, and rupture status. While the Spetzler-Martin grade was also similar between the two groups, the location of the AVM nidus in the eloquent area was slightly higher in patients in the Onyx group (72.7%) than in patients in the pre-Onyx group (43.8%) ( = 0.09). The embolization rate was higher in the pre-Onyx group (mean: 63.0%; range: 12.7-100%) than in the Onyx group (mean: 50.0%; range: 15.8-100%), but the difference was not statistically significant ( = 0.06). The time needed for surgical removal was shorter in the Onyx group (mean: 354.8 min; range: 144-884 min) than in the pre-Onyx group (mean: 457.9 min; range: 240-1,294 min); however, this difference was not statistically significant ( = 0.13). The amount of intraoperative bleeding was significantly lower in the Onyx group (mean: 129.8 ml; range: 20-540 mL) than in the pre-Onyx group (mean: 448.8 mL; range: 120-1,550 ml) ( = 0.0008). The surgical complication rates were comparable between the two groups (pre-Onyx group, 18.8%; Onyx group, 4.5%; = 0.29). Pre-operative embolization with Onyx can significantly reduce the amount of intraoperative bleeding in AVM resection and may contribute to safe AVM surgery.