Comparison of N-butyl cyanoacrylate and onyx for the embolization of intracranial arteriovenous malformations: analysis of fluoroscopy and procedure times

Neurosurgery. 2008 Jul;63(1 Suppl 1):ONS73-8; discussion ONS78-80. doi: 10.1227/01.neu.0000335015.83616.12.


Objective: Intracranial arteriovenous malformations (AVM) may be managed through staged preoperative embolization and resection. Two commonly used liquid embolics are N-butyl cyanoacrylate (nBCA; Cordis Microvascular, Inc., New Brunswick, NJ) and Onyx (ev3, Inc., Irvine, CA). We sought to compare the utility of these agents in terms of fluoroscopy and procedure times.

Methods: All intracranial AVMs embolized from 2002 to 2006 at the University of Florida were included in this study. Patients were stratified into three treatment groups: nBCA, Onyx, and patients who received both nBCA and Onyx during separate embolizations. Cohorts were compared by sex, age, Spetzler-Martin grade, AVM volume, fluoroscopy time, procedure time, surgical blood loss, and complications.

Results: A total of 182 embolizations were performed on 88 patients (nBCA, 60 patients and 106 procedures; Onyx, 20 patients and 43 procedures; and nBCA/Onyx, eight patients and 16 nBCA and 17 Onyx procedures). There were no significant differences in patient demographics, AVM volumes, and Spetzler-Martin grades. Mean fluoroscopy and procedure times were increased for Onyx (57 min; 2.6 h) compared with nBCA (37 min; 2.1 h) embolizations (P < 0.0001 and P = 0.001, respectively). Cumulative mean fluoroscopy time was increased for Onyx (135 min) and nBCA/Onyx (180 min) cohorts relative to nBCA (64 min; P < 0.0001). Cumulative mean procedure time was increased in the nBCA/Onyx group (10.4 h) compared with nBCA (3.7 h) and Onyx (5.4 h; P < 0.0001). Seventy patients (80%) underwent AVM resection. No significant differences in surgical blood loss or complication rates were observed among the cohorts.

Conclusion: Onyx AVM embolization requires increased fluoroscopy and procedure times compared with nBCA. Further investigation is necessary to justify increased radiation exposure and procedure time associated with Onyx.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Cohort Studies
  • Dimethyl Sulfoxide / administration & dosage*
  • Dimethyl Sulfoxide / chemistry
  • Embolization, Therapeutic / methods*
  • Enbucrilate / administration & dosage*
  • Enbucrilate / chemistry
  • Female
  • Fluoroscopy / methods
  • Humans
  • Intracranial Arteriovenous Malformations / pathology
  • Intracranial Arteriovenous Malformations / therapy*
  • Male
  • Middle Aged
  • Polyvinyls / administration & dosage*
  • Polyvinyls / chemistry
  • Prospective Studies
  • Time Factors


  • Onyx copolymer
  • Polyvinyls
  • Enbucrilate
  • Dimethyl Sulfoxide