• Iruena Kessler, Roberto Riva, Maria Ruggiero, Monica Manisor, Maher Al-Khawaldeh, and Charbel Mounayer.
• Department of Interventional Neuroradiology, University of Brasília, Brasília, Brazil.
• Neurosurgery. 2011 Jul 1;69(1):184-93; discussion 193.

BackgroundThere is an increasing application of endovascular treatment for brain arteriovenous malformations (BAVMs) using ethylene vinyl alcohol copolymer (Onyx). Historically, this treatment has been performed using a transarterial approach.ObjectiveTo report our experience with transvenous endovascular embolization with Onyx (TVEO).MethodsFive consecutive patients with BAVMs underwent endovascular TVEO between June 2007 and March 2009 at the Interventional Neuroradiology Department of the University Hospital of Limoges. There were 3 men and 2 women with a mean age of 41.8 years (range, 19-57 years). The clinical presentation included symptoms caused by intracerebral hemorrhage (n = 4) and seizures (n = 1). According to the Spetzler-Martin classification scheme, 3 BAVMs (60%) were grade III, and 2 BAVMs (40%) were grade IV. Four BAVMs (80%) were supratentorial and 1 BAVM (20%) was infratentorial. Immediate and mid-term treatment (6 months) outcomes were angiographically and clinically analyzed according to the modified Rankin Scale.ResultsThe transvenous approach was used in all patients (100%). The success rate of complete obliteration of the arteriovenous malformation nidus was 80% (4 of 5), confirmed by follow-up angiography performed immediately and at 6 months after TVEO. No procedure-related complications occurred during or after embolization. All patients remained unchanged (modified Rankin Scale score = 0-2) and clinically stable 6 months after TVEO.ConclusionThe transvenous approach using Onyx for the management of BAVMs is shown to be an efficient and safe alternative treatment in cases with no other conventional therapeutic choice and when some anatomic considerations are respected.

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