The utility of Onyx for preoperative embolization of cranial and spinal tumors

OBJECTIVE: To assess the utility, technical factors, and complications associated with the use of Onyx (Micro Therapeutics, Inc., Irvine, CA) for preVerative embolization of cranial and spinal tumors. METHODS: We reviewed a prospectively accumulated clatal?ase for patients in whom Onyx was used for preoperative embolization of cranial anc spinal tumors over a 19month period. The patients' demographic characteristics, iumor type and location, embolic agents used, arteries catheterized, and associated cor)plications were assessed. Specific attention was focused on technical factors associated with the use of Onyx that differed from the use of other commonly used embolic materials. RESULTS: Ten patients (four female and six male; age range, J 1-60 yr) underwent preoperative embolization with Onyx before cranial or spinal tumor resection. Tumors included three juvenile nasal angiofibromas, two meningiom&, two hemangioblastomas, two metastases (renal cell and thyroid), and one giant cell tumor. Onyx embolization was performed in 43 vessels over 11 treatment sessions. There wen's no complications related to the embolization procedures. Deep penetration of the embol c agent into the tumor was documented through preoperative imaging or surgical pathological specimens. CONCLUSION: Preoperative embolization of cranial and !,pinal tumors can be performed safely. Specific technical advantages of Onyx included deep penetration of lesions producing extensive tumor infarction, the ability to eribolize extensive portions of the tumors through fewer arterial catheterizations, and the safety of catheter withdrawal despite often substantial reflux along the embolic catheter.