{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T10:53:55Z","timestamp":1791111235223,"version":"4.1.0"},"reference-count":30,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JNS"],"published-print":{"date-parts":[[2011,7]]},"abstract":"<jats:sec>\n<jats:title>Object<\/jats:title>\n<jats:p>The purpose of this study was to present the authors' clinical experience and long-term angiographic and clinical follow-up results in 350 patients with brain arteriovenous malformations (AVMs) treated using prolonged intranidal Onyx injection with a very slow \u201cstaged\u201d reflux technique described by the authors.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>Three hundred and fifty consecutive patients with brain AVMs treated using Onyx between 1999 and 2008 and in whom definitive status for endovascular treatment was reached are presented. There were 206 (59%) male and 144 (41%) female patients, with a mean age of 34 years. There were 607 endovascular sessions performed. Onyx was the only agent used for intranidal injections in all patients, but in 42 patients high-concentration <jats:italic>N<\/jats:italic>-butyl cyanoacrylate glue was used adjunctively to close high-flow direct arteriovenous intra- or perinidal fistulas, or when a feeding vessel or nidus perforation and\/or dissection occurred.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>Angiographically confirmed obliteration was achieved in 179 patients (51%) with only endovascular treatment; 1 patient died due to intracranial hemorrhage after the treatment. Twenty-two patients underwent resection, and 136 patients were sent to radiosurgery after endovascular treatment. In 4 patients embolization therapy was discontinued, and 5 additional patients refused the suggested complementary surgery. In all 178 surviving patients who had angiographically confirmed AVM obliteration by embolization alone, 1\u20138 years of control angiography (mean 47 months) confirmed stable obliteration, except for 2 patients in whom a very small recruitment was noted in the 1st year on control angiography studies, despite initial apparent total obliteration (recanalization rate 1.1%). In the entire series, 5 patients died; the mortality rate was 1.4%. The permanent morbidity rate was 7.1%.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>With the prolonged intranidal injection technique described herein, Onyx allows the practitioner to achieve higher rates of anatomical cures compared with the cure rates obtained previously with other embolic agents. More importantly, due to this technique's much more effective intranidal penetration, it allows high-grade AVMs to be made radiosurgically treatable in a group of patients for whom there has been no treatment alternative.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2011.2.jns09830","type":"journal-article","created":{"date-parts":[[2011,4,8]],"date-time":"2011-04-08T16:27:03Z","timestamp":1302280023000},"page":"78-88","source":"Crossref","is-referenced-by-count":260,"title":["Endovascular treatment of brain arteriovenous malformations with prolonged intranidal Onyx injection technique: long-term results in 350 consecutive patients with completed endovascular treatment course"],"prefix":"10.3171","volume":"115","author":[{"given":"Isil","family":"Saatci","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Serdar","family":"Geyik","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kivilcim","family":"Yavuz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H. Saruhan","family":"Cekirge","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-jns09830","series-title":"J Neurosurg","first-page":"173A","article-title":"Long intranidal Onyx injections in the endovascular treatment of pial brain AVMs: description of a new technique and philosophy aimed at cure","volume":"96","author":"Cekirge","year":"2002"},{"key":"b2-jns09830","series-title":"J Neurol Neurosurg Psychiatry","first-page":"1","article-title":"Arteriovenous malformations of the brain: natural history in unoperated patients","volume":"49","author":"Crawford","year":"1986"},{"key":"b3-jns09830","series-title":"AJNR Am J Neuroradiol","first-page":"162","article-title":"Endovascular treatment of intracerebral arteriovenous malformations: procedural safety, complications, and results evaluated by MR imaging, including diffusion and perfusion imaging","volume":"27","author":"Cronqvist","year":"2006"},{"key":"b4-jns09830","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":"b5-jns09830","series-title":"J Neurosurg","first-page":"19","article-title":"Treatment of brain arteriovenous malformations by embolization and radiosurgery","volume":"85","author":"Gobin","year":"1996"},{"key":"b6-jns09830","series-title":"J Neurosurg","first-page":"3","article-title":"Intention-to-treat analysis of Spetzler-Martin grades IV and V arteriovenous malformations: natural history and treatment paradigm","volume":"98","author":"Han","year":"2003"},{"key":"b7-jns09830","series-title":"J Neurosurg","first-page":"226","article-title":"Complications of embolization of arteriovenous malformations of the brain","volume":"104","author":"Haw","year":"2006"},{"key":"b8-jns09830","series-title":"Neurol Res","first-page":"479","article-title":"Endovascular therapy of brain AVMs prior to radiosurgery","volume":"20","author":"Henkes","year":"1998"},{"key":"b9-jns09830","series-title":"Neurosurgery","first-page":"823","article-title":"Natural history of brain arteriovenous malformations: a long-term follow-up study of risk of hemorrhage in 238 patients","volume":"63","author":"Hernesniemi","year":"2008"},{"key":"b10-jns09830","series-title":"Surg Neurol","first-page":"562","article-title":"Microsurgical removal of a free segment of microcatheter in the anterior circulation as a complication of embolization","volume":"46","author":"Inci","year":"1996"},{"key":"b11-jns09830","series-title":"Neurosurgery","first-page":"984","article-title":"Embolization of arteriovenous malformations with Onyx: clinicopathological experience in 23 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malformations","volume":"63","author":"Laakso","year":"2008"},{"issue":"1 Suppl","key":"b16-jns09830","series-title":"Neurosurgery","first-page":"417","article-title":"Surgical risks associated with the management of Grade I and II brain arteriovenous malformations","volume":"61","author":"Morgan","year":"2007"},{"key":"b17-jns09830","series-title":"AJNR Am J Neuroradiol","first-page":"518","article-title":"Nidal embolization of brain arteriovenous malformations using Onyx in 94 patients","volume":"28","author":"Mounayer","year":"2007"},{"key":"b18-jns09830","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-jns09830","series-title":"Am J Neuroradiol AJNR","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-jns09830","series-title":"J Neurosurg","first-page":"387","article-title":"The natural history of symptomatic arteriovenous malformations of the brain: a 24-year follow-up assessment","volume":"73","author":"Ondra","year":"1990"},{"key":"b21-jns09830","series-title":"AJNR Am J Neuroradiol","first-page":"99","article-title":"Embolization of intracranial arteriovenous malformations with ethylene-vinyl alcohol copolymer (Onyx)","volume":"30","author":"Panagiotopoulos","year":"2009"},{"key":"b22-jns09830","series-title":"J Neuroradiol","first-page":"147","article-title":"Acute spontaneous hemorrhage after embolization of brain arteriovenous malformation with N-butyl cyanoacrylate","volume":"28","author":"Picard","year":"2001"},{"key":"b23-jns09830","series-title":"AJNR Am J Neuroradiol","first-page":"501","article-title":"Preoperative embolization of cerebral arteriovenous malformations with polyvinyl alcohol particles: experience in 51 adults","volume":"11","author":"Purdy","year":"1990"},{"key":"b24-jns09830","series-title":"Clin Neurosurg","first-page":"651","article-title":"Normal perfusion pressure breakthrough theory","volume":"25","author":"Spetzler","year":"1978"},{"key":"b25-jns09830","series-title":"Adv Tech Stand Neurosurg","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1007\/978-3-7091-6504-1_4","article-title":"The endovascular treatment of brain arteriovenous malformations","volume":"24","author":"Valavanis","year":"1998"},{"key":"b26-jns09830","series-title":"AJNR Am J Neuroradiol","first-page":"172","article-title":"Brain AVM embolization with Onyx","volume":"28","author":"van Rooij","year":"2007"},{"key":"b27-jns09830","series-title":"AJNR Am J Neuroradiol","first-page":"371","article-title":"Endovascular treatment of intracranial arteriovenous malformations with onyx: technical aspects","volume":"28","author":"Weber","year":"2007"},{"key":"b28-jns09830","series-title":"Neurosurgery","first-page":"448","article-title":"Embolization of cerebral arteriovenous malformations: Part I\u2014Technique, morphology, and complications","volume":"39","author":"Wikholm","year":"1996"},{"key":"b29-jns09830","series-title":"AJNR Am J Neuroradiol","first-page":"1103","article-title":"Characteristics of ethylene vinyl alcohol copolymer (EVAL) mixtures","volume":"15","author":"Yamashita","year":"1994"},{"key":"b30-jns09830","series-title":"AJNR Am J Neuroradiol","first-page":"177","article-title":"Surgically confirmed incorporation of a chronically retained neurointerventional microcatheter in the carotid artery","volume":"20","author":"Zoarski","year":"1999"}],"container-title":["Journal of 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article"],"short-title":[],"issued":{"date-parts":[[2011,7]]},"references-count":30,"journal-issue":{"issue":"1"},"URL":"https:\/\/doi.org\/10.3171\/2011.2.jns09830","relation":{},"ISSN":["0022-3085","1933-0693"],"issn-type":[{"value":"0022-3085","type":"print"},{"value":"1933-0693","type":"electronic"}],"subject":[],"published":{"date-parts":[[2011,7]]}}}