{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T13:27:04Z","timestamp":1791293224046,"version":"4.1.0"},"reference-count":31,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JNS"],"published-print":{"date-parts":[[2010,10]]},"abstract":"\nObject<\/jats:title>\nThe Onyx liquid embolic system (Onyx) was approved in the European Union in 1999 for embolization of lesions in the intracranial and peripheral vasculature, including brain arteriovenous malformations (AVMs) and hypervascular tumors. In 2001 a prospective, equivalence, multicenter, randomized controlled trial was initiated to support a submission for FDA approval. The objective of this study was to verify the safety and efficacy of Onyx compared with N<\/jats:italic>-butyl cyanoacrylate (NBCA) for the presurgical treatment of brain AVMs.<\/jats:p><\/jats:sec>\n\nMethods<\/jats:title>\nOne hundred seventeen patients with brain AVMs were treated with either Onyx (54 patients) or NBCA (63 patients) for presurgical endovascular embolization between May 2001 and April 2003. The primary end point was technical success in achieving \u2265 50% reduction in AVM volume. Secondary end points were operative blood loss and resection time. All adverse events (AEs) were reported and assigned a relationship to the Onyx or NBCA system, treatment, disease, surgery, or other\/unknown. The Data Safety Monitoring Board adjudicated AEs, and a blinded, independent core lab assessed volume measurements. Patients were monitored through discharge after the final surgery or through a 3- and\/or 12-month follow-up if resection had not been performed or was incomplete.<\/jats:p><\/jats:sec>\n\nResults<\/jats:title>\nThe use of Onyx led to \u2265 50% AVM volume reduction in 96% of cases versus 85% for NBCA (p = not significant). The secondary end points of resection time and blood loss were similar. Serious AEs were also similar between the 2 treatment groups.<\/jats:p><\/jats:sec>\n\nConclusions<\/jats:title>\nOnyx is equivalent to NBCA in safety and efficacy as a preoperative embolic agent in reducing brain AVM volume by at least 50%.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2010.3.jns09370","type":"journal-article","created":{"date-parts":[[2010,4,30]],"date-time":"2010-04-30T14:15:20Z","timestamp":1272636920000},"page":"733-741","source":"Crossref","is-referenced-by-count":167,"title":["A prospective, multicenter, randomized trial of the Onyx liquid embolic system and N-butyl cyanoacrylate embolization of cerebral arteriovenous malformations"],"prefix":"10.3171","volume":"113","author":[{"given":"Yince","family":"Loh","sequence":"first","affiliation":[{"name":"Department of Medicine, Neurovascular Service, Madigan Army Medical Center, Tacoma, Washington;"},{"name":"Department of Radiology, Division of Interventional Neuroradiology, David Geffen School of Medicine at UCLA, Los Angeles, California; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gary R.","family":"Duckwiler","sequence":"additional","affiliation":[{"name":"Department of Radiology, Division of Interventional Neuroradiology, David Geffen School of Medicine at UCLA, Los Angeles, California; and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-jns09370","series-title":"J Neurosurg","first-page":"366","article-title":"Surgical handling characteristics of an ethylene vinyl alcohol copolymer compared with N-butyl cyanoacrylate used for embolization of vessels in an arteriovenous malformation resection model in swine","volume":"98","author":"Akin","year":"2003"},{"key":"b2-jns09370","series-title":"Neuroradiology","first-page":"1012","article-title":"Transvenous injection of Onyx for casting of the cavernous sinus for the treatment of a carotid-cavernous fistula","volume":"46","author":"Arat","year":"2004"},{"key":"b3-jns09370","series-title":"Radiology","first-page":"609","article-title":"Treatment of intracerebral arteriovenous malformations with isobutyl 2-cyanoacrylate: initial clinical experience","volume":"139","author":"Bank","year":"1981"},{"key":"b4-jns09370","series-title":"AJNR Am J Neuroradiol","first-page":"777","article-title":"n-Butyl 2-cyanoacrylate\u2014substitute for IBCA in interventional neuroradiology: histopathologic and polymerization time studies","volume":"10","author":"Brothers","year":"1989"},{"key":"b5-jns09370","series-title":"J Neurosurg","first-page":"1120","article-title":"Treatment of dural arteriovenous fistula using ethylene vinyl alcohol (onyx) arterial embolization as the primary modality: short-term results","volume":"107","author":"Carlson","year":"2007"},{"key":"b6-jns09370","series-title":"Neurosurgery","first-page":"112","article-title":"Embolization of the nidus of brain arteriovenous malformations with n-butyl cyanoacrylate","volume":"40","author":"Debrun","year":"1997"},{"key":"b7-jns09370","series-title":"J Neurosurg","first-page":"615","article-title":"Embolization of cerebral arteriovenous malformations with bucrylate","volume":"56","author":"Debrun","year":"1982"},{"key":"b8-jns09370","series-title":"AJNR Am J Neuroradiol","first-page":"1900","article-title":"Organic solvents as vehicles for precipitating liquid embolics: a comparative angiotoxicity study with superselective injections of swine rete mirabile","volume":"27","author":"Dudeck","year":"2006"},{"key":"b9-jns09370","series-title":"Clin Neuropathol","first-page":"13","article-title":"Combined therapy of cerebral arteriovenous malformations: histological differences between a non-adhesive liquid embolic agent and n-butyl 2-cyanoacrylate (NBCA)","volume":"21","author":"Duffner","year":"2002"},{"key":"b10-jns09370","series-title":"J Neurosurg","first-page":"228","article-title":"Endovascular treatment of intracerebral arteriovenous malformations: experience in 49 cases","volume":"75","author":"Fournier","year":"1991"},{"key":"b11-jns09370","series-title":"J Neurosurg","first-page":"60","article-title":"The effect of embolization with N-butyl cyanoacrylate prior to surgical resection of cerebral arteriovenous malformations","volume":"78","author":"Jafar","year":"1993"},{"key":"b12-jns09370","series-title":"Neurosurgery","first-page":"984","article-title":"Embolization of arteriovenous malformations with Onyx: clinicopathological experience in 23 patients","volume":"48","author":"Jahan","year":"2001"},{"key":"b13-jns09370","series-title":"Neuroradiology","first-page":"589","article-title":"Curative embolization of cerebral arteriovenous malformations (AVMs) with Onyx in 101 patients","volume":"50","author":"Katsaridis","year":"2008"},{"key":"b14-jns09370","series-title":"J Neurosurg","first-page":"443","article-title":"Surgical embolization of cerebral arteriovenous malformations through internal carotid and vertebral arteries. Long-term results","volume":"42","author":"Luessenhop","year":"1975"},{"key":"b15-jns09370","series-title":"Urology","first-page":"1136","article-title":"Intravesical dimethyl sulfoxide for primary amyloidosis of the bladder","volume":"52","author":"McCammon","year":"1998"},{"issue":"1 Suppl","key":"b16-jns09370","series-title":"J Clin Neurosci","first-page":"82","article-title":"Embolisation of cerebral arteriovenous malformations to assure successful subsequent radiosurgery","volume":"7","author":"Miyachi","year":"2000"},{"issue":"4 Suppl","key":"b17-jns09370","series-title":"Urology","first-page":"73","article-title":"Rational approaches to the treatment of patients with interstitial cystitis","volume":"69","author":"Moldwin","year":"2007"},{"key":"b18-jns09370","series-title":"Neurosurgery","first-page":"1164","article-title":"Nonadhesive liquid embolic agent for cerebral arteriovenous malformations: preliminary histopathological studies in swine rete mirabile","volume":"43","author":"Murayama","year":"1998"},{"key":"b19-jns09370","series-title":"AJNR Am J Neuroradiol","first-page":"748","article-title":"N-butyl cyanoacrylate embolization of cerebral arteriovenous malformations: results of a prospective, randomized, multi-center trial","volume":"23","author":"n-BCA Trial Investigators","year":"2002"},{"key":"b20-jns09370","series-title":"Neurosurgery","first-page":"1213","article-title":"Multimodality treatment of brain arteriovenous malformations with microsurgery after embolization with onyx: single-center experience and technical nuances","volume":"62","author":"Natarajan","year":"2008"},{"key":"b21-jns09370","series-title":"Neuroradiology","first-page":"380","article-title":"A contribution to the controversy over dimethyl sulfoxide toxicity: anesthesia monitoring results in patients treated with Onyx embolization for intracranial aneurysms","volume":"47","author":"Pamuk","year":"2005"},{"issue":"1 Suppl","key":"b22-jns09370","series-title":"J Clin Neurosci","first-page":"60","article-title":"Strategy for the treatment of arteriovenous malformations","volume":"7","author":"Sano","year":"2000"},{"key":"b23-jns09370","series-title":"Neurosurgery","first-page":"408","article-title":"Transarterial embolization of clival dural arteriovenous fistulae using liquid embolic agents","volume":"62","author":"Shi","year":"2008"},{"key":"b24-jns09370","series-title":"J Neurosurg","first-page":"17","article-title":"Surgical management of large AVM's by staged embolization and operative excision","volume":"67","author":"Spetzler","year":"1987"},{"key":"b25-jns09370","series-title":"J Neurosurg","first-page":"810","article-title":"Complications of preoperative embolization of cerebral arteriovenous malformations","volume":"100","author":"Taylor","year":"2004"},{"key":"b26-jns09370","series-title":"Proc Natl Acad Sci U S A","first-page":"364","article-title":"Aggregation phenomena in polyvinyl alcohol-acetate solutions","volume":"35","author":"Timasheff","year":"1949"},{"key":"b27-jns09370","series-title":"Summary of Safety and Effectiveness Data (SSED)","author":"US Food and Drug Administration","year":"2005"},{"key":"b28-jns09370","series-title":"J Neurosurg","first-page":"819","article-title":"Pathology of arteriovenous malformations embolized with isobutyl-2-cyanoacrylate (bucrylate). Report of two cases","volume":"55","author":"Vinters","year":"1981"},{"key":"b29-jns09370","series-title":"Neuroradiology","first-page":"279","article-title":"The histotoxicity of cyanoacrylates. A selective review","volume":"27","author":"Vinters","year":"1985"},{"key":"b30-jns09370","series-title":"Neurosurgery","first-page":"606","article-title":"The safety and effectiveness of brain arteriovenous malformation embolization using acrylic and particles: the experiences of a single institution","volume":"37","author":"Wallace","year":"1995"},{"key":"b31-jns09370","series-title":"AJNR Am J Neuroradiol","first-page":"479","article-title":"Occlusion of cerebral arteriovenous malformations with N-butyl cyano-acrylate is permanent","volume":"16","author":"Wikholm","year":"1995"}],"container-title":["Journal of Neurosurgery"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/113\/4\/article-p733.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/113\/4\/article-p733.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/113\/4\/article-p733.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,3,27]],"date-time":"2023-03-27T04:44:37Z","timestamp":1679892277000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/113\/4\/article-p733.xml"}},"subtitle":["Clinical article"],"short-title":[],"issued":{"date-parts":[[2010,10]]},"references-count":31,"journal-issue":{"issue":"4"},"URL":"https:\/\/doi.org\/10.3171\/2010.3.jns09370","relation":{},"ISSN":["0022-3085","1933-0693"],"issn-type":[{"value":"0022-3085","type":"print"},{"value":"1933-0693","type":"electronic"}],"subject":[],"published":{"date-parts":[[2010,10]]}}}