الفهرس 
Anatomy of brain vesselsOnly 14 pages are availabe for public view
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Abstract
The natural history of bAVMs is not well known until now. Several criteria are needed for the therapeutic decisions including patient specific criteria, risk factors of the bAVM itself and any associated vascular abnormalities.
In Our study, 30 patients with bAVMS of different clinical presentations were treated over 70 sessions of endovascular treatment using Onyx with failure to treat in 2 sessions and the use of NBCA in one session.
The advancement in microcatheters, micro-guidewires and angiography machines including 3D angiography increased dramatically the success in accessing difficult bAVMs, controlling the procedure and achieving better results.
Selective angiography is mandatory to understand the characteristics of bAVMs and for the therapeutic decision.
Onyx itself is a revolutionary tool in treating bAVMs. Due to its unique characteristics, it provides controlled, staged injections over much longer interval of time. This provides less proximal reflux in the arterial feeders, more penetration into nidus, less obliteration of draining veins and even the possibility for simultaneous angiographic control through the guiding catheters to assess the progression of bAVM occlusion.
The use of Onyx in the treatment of bAVMs requires highly skilled experienced hands and highly professional referral neuroradiology centers alongside with a highly specialized neuro-intensive care unit and neurosurgery department to achieve favorable results.
The rate of complete cure of bAVMs treated with Onyx in our study is significant compared to that of bAVMs treated with NBCA in the literature. Moreover, in comparison to other studies in the literature using Onyx for the treatment of bAVMS, the complete cure rate, obliteration of more than 90% of nidal volume and the global average obliteration rate in our study population lies within the high average rates.
The morbido-mortality rates in our study are within the limits in comparison to other recent series in the literature.
In conclusion, Onyx provides a safe and highly effective treatment of bAVMs as demonstrated. More randomized clinical trials are needed to; evaluate the outcome of using combined techniques with it (surgery and radiosurgery) and even more, to study the therapeutic decision itself regarding natural history of bAVMs.