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Mohamed Samy Elhammady, Stacey Quintero Wolfe, Hamad Farhat, Roham Moftakhar and Mohammad Ali Aziz-Sultan

O nyx (Micro Therapeutics, Inc.) is a nonadhesive liquid embolic agent composed of ethylene vinyl alcohol copolymer suspended in DMSO with tantalum added for radiopacity. The FDA initially approved it in 2005 for the treatment of cerebral arteriovenous malformations. Onyx has since gained widespread use, and its applications have expanded to the embolization of spinal and cranial arteriovenous fistulas, tumors, and, more recently, aneurysms. The role of Onyx in the treatment of CCFs, however, has not been well-documented and has been largely limited to case

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Ross C. Puffer, David J. Daniels, David F. Kallmes, Harry J. Cloft and Giuseppe Lanzino

sinus lend themselves to endovascular treatment with either transvenous or transarterial embolization, tentorial DAVFs have often necessitated surgical disconnection to achieve a permanent cure. Many tentorial DAVFs drain directly into subarachnoid veins, making transvenous access impossible. 3 , 4 , 7 , 8 , 12 The Onyx Liquid Embolic System (Covidien) was approved by the FDA in 2005 for the treatment of intracranial arteriovenous malformations but has been used off label for the treatment of DAVFs. 1 , 11 , 14 The availability of Onyx has introduced a new

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Brian T. Jankowitz, Nirav Vora, Tudor Jovin and Michael Horowitz

. Endovascular embolization has now become the standard of care in the treatment of VOGMs. Improvements in catheters and embolization devices have greatly expanded the utility of endovascular treatment. The Onyx liquid embolic system (ev3, Inc.) is a cohesive polymer of ethylene vinyl alcohol and DMSO that was approved in 2005 by the US Food and Drug Administration for the presurgical embolization of brain AVMs in adults. We report the utility of this unique polymer in the treatment of pediatric vascular malformations. Methods The records of 6 children (age < 18 years

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Maryam Soltanolkotabi, Samantha E. Schoeneman, Tord D. Alden, Michael C. Hurley, Sameer A. Ansari, Arthur J. DiPatri Jr., Tadanori Tomita and Ali Shaibani

. Recent advances in the embolization technique include the development of low-profile, trackable microwire and flow-directed microcatheters. Furthermore, the increased use of liquid embolic agents, most recently ethylene-vinyl alcohol copolymer (EVOH, Onyx, ev3 Neurovascular), aims for either the preoperative reduction of the brain AVM size or an anatomical cure, which is achievable in only a limited number of patients. Onyx is a newer liquid polymerizing embolic agent, which permits theoretically slower filling as well as better penetration and obliteration of the

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Peter Adamczyk, Arun Paul Amar, William J. Mack and Donald W. Larsen

embolizations performed using Onyx (ev3 Neurovascular), a novel ethylene vinyl alcohol copolymer preparation with low viscosity and delayed precipitation. 30 While many authors have reported high curative rates, the long-term durability of such treatments remains uncertain as DAVF recurrence has been observed in patients after successful treatment. 9 , 13 , 27 We report 3 cases of apparent cure of intracranial and spinal DAVFs that developed subsequent recanalization despite the documented presence of Onyx in the draining vein, and we review the literature for DAVF

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Mohamed Samy A. Elhammady, Hamad Farhat, Habib Ziayee and Mohammad Ali Aziz-Sultan

C arotid body tumors are rare, highly vascular lesions that frequently require preoperative embolization to minimize surgical morbidity secondary to blood loss. Embolization has typically been performed via a transarterial route. We present a case of CBT that underwent direct intralesional embolization using Onyx (ev3; ethylene vinyl alcohol copolymer). Case Report Examination During a workup for dizziness, this 70-year-old previously healthy man was found to have a right-sided soft, pulsatile neck mass. The remainder of his head and neck

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Mohammad Ali Aziz-Sultan, Roham Moftakhar, Stacey Quintero Wolfe, Mohamed Samy Elhammady, Björn Herman and Hamad Farhat

tumors has limitations 2 and alternative techniques for embolization are under development. Direct percutaneous embolization of JNAs was first described in 1994. 10 All reported cases of direct percutaneous embolization of JNAs have been performed using NBCA or PVA. 2 , 10 In this report we describe a novel method of using an endoscopically assisted transnasal approach for direct intratumoral embolization of JNAs using the liquid embolic agent Onyx (ev3), which is an ethylene vinyl alcohol copolymer. Case Report History and Examination This 13-year

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Mohamed Samy Elhammady, Stacey Quintero Wolfe, Ramsey Ashour, Hamad Farhat, Roham Moftakhar, Baruch B. Lieber and Mohammad Ali Aziz-Sultan

E ndovascular surgery has become an important tool in the treatment of various tumors. Preoperative embolization of vascular tumors to decrease intraoperative blood loss, palliative embolization to control intractable tumor bleeding, and administration of intraarterial chemotherapy have become common practice. Tumor embolizations have traditionally been performed using numerous materials, including silk, gelfoam, fibrin glue, gelatin spheres, PVA, and NBCA. Onyx (EV3 Inc.), an ethylene vinyl alcohol copolymer, is a newer liquid embolic agent that was

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Ricky Medel, R. Webster Crowley, D. Kojo Hamilton and Aaron S. Dumont

therapeutic challenge for both clipping and coil embolization due to their friable nature and lack of an intact arterial wall. Even though endovascular treatment has emerged as an important therapeutic option, sparse literature exists regarding the use of liquid embolic agents, especially Onyx (Micro Therapeutics, Inc.). 7 We present a case of a pediatric patient with an iatrogenic pseudoaneurysm that was treated with Onyx embolization. Case Report Presentation This 16-year-old boy with acromegaly presented to the University of Virginia Health System for

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Katrin Van Loock, Tomas Menovsky, Maurits H. Voormolen, Mark Plazier, Paul Parizel, Dirk De Ridder, Andrew I. R. Maas and Juha A. Hernesniemi

S urgical clipping of incompletely obliterated cerebral aneurysms following endovascular treatment with platinum coils and removal of the coil mass for compression syndromes has been extensively described in the literature. 4 , 5 , 9 , 10 , 12 In contrast, there are few data related to problems associated with the use of the liquid embolic agent Onyx HD-500 (ev3, Inc.) for endovascular treatment of aneurysms, and to our knowledge there are no data on appropriate techniques for surgical removal of this solid polymer material. In this case report, we