The era of Onyx embolization: A systematic and literature review of preoperative embolization before stereotactic radiosurgery for the management of cerebral arteriovenous malformations. [Review]
The era of Onyx embolization: A systematic and literature review of preoperative embolization before stereotactic radiosurgery for the management of cerebral arteriovenous malformations. [Review]
- 2022
CONCLUSION: Onyx (ethylene vinyl-alcohol (EVOH) copolymer dissolved in dimethyl sulfoxide (DMSO) and suspended in micronized tantalum powder) has been increasingly used for the embolization of intracranial AVMs with increased success regarding its ease of use from a technical standpoint and performs similarly to other embolysate materials. Copyright © 2022 The Author(s). Published by Elsevier Inc. All rights reserved. INTRODUCTION: The current treatment paradigm for intracranial arteriovenous malformations (AVMs) focuses on reducing the risk of intracranial hemorrhage using various therapeutic means including embolization, stereotactic radiosurgery (SRS), and microsurgical resection. To improve AVM obliteration rates with SRS, pre-radiosurgical embolization has been trialed in a number of studies to reduce the volume of the AVM nidus prior to radiosurgery. This study aimed to review the efficacy of pre-radiosurgical embolization in the pre-Onyx era compared to the current Onyx era. METHODS: A systematic review was performed using PubMed to identify studies with 20 or more AVM patients, embolization material, and obliteration rates for both E+SRS (embolization + stereotactic radiosurgery) and SRS only groups. RESULTS: Seventeen articles consisting of 1133 eligible patients were included in this study. 914 (80.7%) patients underwent embolization prior to SRS. Onyx was used as the embolysate in 340 (37.2%) patients in the E+SRS cohorts. Mean obliteration rate for the embolized cohort was 46.9% versus 46.5% in the SRS only cohort. When comparing obliteration rates based on embolysate material, obliteration rates with Onyx+SRS were 42.1% and 50.0% in the non-Onyx embolysate + SRS cohort.
English
1878-8750
10.1016/j.wneu.2022.11.058 [doi] S1878-8750(22)01610-2 [pii]
IN PROCESS -- NOT YET INDEXED
MedStar Washington Hospital Center
Neurosurgery
Journal Article
Review
CONCLUSION: Onyx (ethylene vinyl-alcohol (EVOH) copolymer dissolved in dimethyl sulfoxide (DMSO) and suspended in micronized tantalum powder) has been increasingly used for the embolization of intracranial AVMs with increased success regarding its ease of use from a technical standpoint and performs similarly to other embolysate materials. Copyright © 2022 The Author(s). Published by Elsevier Inc. All rights reserved. INTRODUCTION: The current treatment paradigm for intracranial arteriovenous malformations (AVMs) focuses on reducing the risk of intracranial hemorrhage using various therapeutic means including embolization, stereotactic radiosurgery (SRS), and microsurgical resection. To improve AVM obliteration rates with SRS, pre-radiosurgical embolization has been trialed in a number of studies to reduce the volume of the AVM nidus prior to radiosurgery. This study aimed to review the efficacy of pre-radiosurgical embolization in the pre-Onyx era compared to the current Onyx era. METHODS: A systematic review was performed using PubMed to identify studies with 20 or more AVM patients, embolization material, and obliteration rates for both E+SRS (embolization + stereotactic radiosurgery) and SRS only groups. RESULTS: Seventeen articles consisting of 1133 eligible patients were included in this study. 914 (80.7%) patients underwent embolization prior to SRS. Onyx was used as the embolysate in 340 (37.2%) patients in the E+SRS cohorts. Mean obliteration rate for the embolized cohort was 46.9% versus 46.5% in the SRS only cohort. When comparing obliteration rates based on embolysate material, obliteration rates with Onyx+SRS were 42.1% and 50.0% in the non-Onyx embolysate + SRS cohort.
English
1878-8750
10.1016/j.wneu.2022.11.058 [doi] S1878-8750(22)01610-2 [pii]
IN PROCESS -- NOT YET INDEXED
MedStar Washington Hospital Center
Neurosurgery
Journal Article
Review