If anyone is interested RE: PHIL vs Onyx embolisation

Since it seems more people are treated with onyx rather than PHIL and I was treated with PHIL, I thought I’d throw a post up about PHIL vs onyx

This has some good info if you’re interested about the differences and success rates etc

Click on link for article

If you don’t want to read whole article here the conclusion

CONCLUSIONS: PHIL appears to be safe and effective for endovascular treatment of cranial dural arteriovenous fistulas. Short-term angiographic and clinical results are comparable with those of Onyx, with the added advantage of easier preparation and improved homogeneous cast visualization. The use of iodine as a radio-opacifier also produces considerably less artifacts on CT compared with tantalum-based embolic materials.

@AlwaysCurious

You prompted me to have a look at PHIL the other day when we were talking briefly about it. As well as the article you found, I found this kind-of-interesting article that looks a little at the differences between PHIL and Onyx, which to my reading are

  1. A lot less preparation time for the PHIL – no fiddling round with getting the right amount of tantalum included.

  2. Much quicker setting time.

I can’t seem to get a link to the original location but I did download this article the other day, so I’ve re-uploaded it here.

1377.full.pdf (1.1 MB)

I’m thinking that for those of us with pretty high-flow DAVFs that need plugging, the quicker setting time of PHIL might be important, so maybe why you & I received PHIL. Mine was described as “quite big in terms of volume of blood being diverted” (but not very big at all in terms of centimetres on the first MRI that I saw).

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I think you’re right as my only thoughts on why they used PHIL with mine was they had said at one time to me that mine had a lot of reflux (i think that was the term) so I guess they need it to set fast and not go into other areas.

I think reflux means two things… for the AVM itself I think it means that it is pumping blood in a retrograde direction along the veins into which it is discharging.

From reading the attached, I think it then means filling out the supply side of the AVM too much. In both cases it means stuff going upstream rather than downstream.

I had plenty of retrograde flow going on pre op, I’m sure. Weird feelings on top of my head and all sorts.

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Let me chime in here, since I have done more reading on embolizations & materials used more than I have on any other topic - I think

I found this to be quite informative, then I did a bunch of reading with the info I found from here

Unfortunately I think the information is a bit dated now, but gives you a good baseline of information to do further research -

My opinion is - whatever the neuro thinks is best. . . Mine, well - these guys are clearly Onyx pushers. Each vile of the stuff is 9k US Dollars. So. . . . But, they seem to have their Onyx techniques down quite quite well(perfected just years ago, is the way I put it) - Seeing this thing with my own working two eyes inside my head while awake - just wow! . . . . . Go figure, seriously. A brain repair made with a epoxy type material that filled a space - it looked so perfect. It’s amazing to me that it could have been done(let alone designed) by another human being - the precision it took & the half dozen failed attempts to get to it - I read all this in the final report. . . Boy, talk about it’s amazing to be alive - let alone, feel as well as I do

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Mike,

I’m with you. To live at a time when brain surgery can be done with glue suits me just perfectly. Having arrived here about 4 years ago to read about different types of intervention for these things, I also felt glad that the one the doc proposed for me was the one I was most comfortable with.

Richard

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And, after mega tons of reading & processing what was done - just in my procedure, is just out of this world

So simple, yet so so effective

Unfortunately, yet very fortunately “we” are on the edge of this frontier - the durability of these is being proven as I type

Yes, I’m sure it is.

As one who’s been here, reading for 4 years, the impression I get is that the extremity AVM people who have embolisations seem to have quite low durability and end up going back time and again. It seems to be much more long-term for brainers, though relatively few brain AVM people on this forum have embolisation as a sole treatment: it seems in the US to be much more frequently used as a bleed-control measure as part of a craniotomy procedure rather than being commonly used alone. I’m encouraged that Barrow have followed embolisation for you. My own personal theory about the better durability for brainers is that there is much better protection from damage to the embolisation because of the skull protecting the area than with an arm or a leg or hand or foot. So, I think we have a decent prognosis as DAVF patients.

I do think some of my external draining veins were PHILled as well as some internal work, so when I fell and hit the back of my head a few weeks ago (and got some interesting noises) I was concerned but it seems to have quietened down again :sweat_smile:

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Sorry to hear you took a fall brother - that’s one thing I always try to tell folk to watch out for - no matter of age or physical condition, it can cause some serious damage - seen it first hand & def would not like to experience it myself(as long as possible, lol)

But, yes - intracranial embolizations seem to be the thing, at Barrow that’s for sure. . . They are very proud of their work & advancements - and, definitely should be

If embolization was not successful, I would have been in serious trouble - I would have had serious deficits if a craniotomy was necessary, due to the location of my AVM & did not qualify at all for Gk. > It’s really awesome to have had such a informative neurosurgeon who gave it to me straight - as rough as it was.

I should post the whole transcript my neurosurgeon had typed up - but, it’s frightening on how many failed attempts they had to make before successfully reaching their destination with the catheter(3rd one)

And, now - finally, I understand on how they came up with the strategy they used to attack this thing

Sorry to hear you fell

What make you think some draining veins were PHILed?

Only because I’m sure that’s what the doc said.

Another thing he said “we used a LOT of glue!”

Most of this encourages me that, despite the fact that my surgery was considered “elective” when I was first assessed in about Oct or Nov 2016 that by the time I got to embolisation in April 2017 it was described as diverting quite a lot of blood and needed lots of glue. I also felt pretty ropey by Easter 2017 and it took me a long time to feel recovered post op.

I’m not the easiest patient and I bother that I worry about operations more than I should but when I reflect on comments like those I’m citing here, I’m more sure I really needed intervention.

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At least unlike mine, yours didn’t blow

I feel so so beyond “lucky” to be where I am today. . . If anything went differently who knows what would of happened

I “was” a terrible patient - done & learned from all that

I’m the best patient now - I just stay knowledgeable of my own issues

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I was only a terrible patient because I didnt take it easy prior to surgery as I was told it doesn’t look too serious… And so I worked insane and ended up in the er dept lol… been taking it easy now post op

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