Use of N-hexyl Cyanoacrylate Monomers for the Treatment of Intra- and Extracranial Arteriovenous Malformations: A Single-Center Experience

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In a retrospective single-center case series (n=22 patients, 24 procedures) with no control group or comparison, Murias Quintana et al. from the Hospital Universitario Central de Asturias, Oviedo, Hospital Clínic de Barcelona, Hospital Universitario Marqués de Valdecilla, Santander, Alfried Krupp Krankenhaus, Essen, Hospital Universitario de Salamanca 1) aim to describe outcomes after the use of N-hexyl cyanoacrylate (NHCA, “Magic Glue”) for AVM embolization. Despite its stated aim of evaluating “strengths and limitations,” the article offers a one-sided, promotional narrative that lacks critical analysis.

🧱 Structural and Conceptual Weaknesses

1. Journal-Level Issues: “Cureus Syndrome”

The journal *Cureus* is increasingly known for:

This paper reinforces that reputation, providing more of a procedural diary than a peer-reviewed study. It embodies editorial complacency and academic dilution.

2. Lowest Tier of Evidence

A retrospective case series offers no comparative insight. There is:

This is not hypothesis–testing research — it’s purely observational, anecdotal reporting.

📉 Methodological Limitations

3. “Success” Is Redefined to Mean Nothing

The paper defines technical success as “the outcome achieved based on objective.” This is circular reasoning and renders the concept of success meaningless.

4. Data Dump of Technical Details

Injection times and catheter models are listed with obsessive detail:

  • HeadWay Duo 167 cm in 70.8%
  • Magic 1.2F in the rest
  • Injection times: 27 seconds to 9 minutes 38 seconds

Yet none of these details translate to improved patient care or clinical insight.

5. Zero Complications ≠ Safety

No adverse events in 24 procedures cannot be extrapolated as “safe.” This cohort is underpowered to detect rare but serious complications — a classic false sense of security.

🤹 Interpretation Bias and Overreach

6. 12.5% Success = “Effective”?

Only '3 out of 24 cases (12.5%)‘ achieved complete occlusion with a single NHCA injection. The authors still call it “effective.” This is an example of:

  • ::unjustified enthusiasm::
  • ::intellectual dishonesty::

7. Promotional Tone

Frequent use of the term “Magic Glue” and positive adjectives for NHCA give this paper the tone of a product brochure, not a neutral scientific analysis.

🧠 What’s Missing?

Key omissions include:

  • No clinical or imaging follow-up data
  • No outcome measures beyond technical success
  • No comparison with other embolic agents (Onyx, PHIL, Squid)
  • No cost-benefit analysis
  • No discussion of failure cases or limitations in complex AVMs

🧾 Conclusion

This paper does not meet the standards of a rigorous scientific study. It provides:

  • No high-quality evidence
  • No clinically useful guidance
  • No long-term data

It reinforces the perception of *Cureus* as a platform for uploading technically correct but scientifically irrelevant work. A procedural note disguised as research, this article is a missed opportunity to meaningfully contribute to the field of neurointerventional radiology.

Final Verdict: This is not a “study” — it is a technical anecdote polished with promotional language and framed in a journal that too often rewards upload volume over scientific substance.

📎 References

1)

Murias Quintana E, Rodríguez Castro J, Puig J, Gil García A, Chapot R, Maestro V, Llibre JC, Gutiérrez Morales JC, García Arias F, Vega P. Use of N-hexyl Cyanoacrylate Monomers for the Treatment of Intra- and Extracranial Arteriovenous Malformations: A Single-Center Experience. Cureus. 2025 May 17;17(5):e84290. doi: 10.7759/cureus.84290. PMID: 40525034; PMCID: PMC12169607.

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