Читать книгу Neurosurgery Outlines - Paul E. Kaloostian - Страница 47

1. Shake Onyx vial on mixer for 20 minutes. Onyx-18 is common, Onyx-34 is suitable for very high flow AVMs, and Onyx-500 is incorporated in aneurysm embolization treatments

2. Wedge microcatheter tip into arterial branch supplying the AVM, preferably very close to the AVM nidus

3. Perform angiography through the microcatheter to confirm that the arterial branch exclusively supplies the AVM

4. Prime the dimethyl sulfoxide (DMSO)-compatible microcatheter (marathon, echelon, rebar, ultraflow) with 0.3 to 0.8 mL DMSO so that Onyx does not solidify in the microcatheter

5. Slowly inject Onyx solution, allowing no more than 1 cm of reflux. If reflux occurs, continue after a 1 to 2 minutes waiting period

6. Halt injection when Onyx no longer flows into the nidus, but refluxes instead