Gamma Knife Surgery for the Treatment of Spontaneous Dural Carotid-Cavernous Fistulas

Onizuka, Masanari; Mori, Katsuharu; Takahashi, Nobuaki; Kawahara, Ichiro; Hiu, Takeshi; Toda, Keisuke; Baba, Hiroshi; Yonekura, Masahiro

doi:10.2176/nmc.43.477

Cited by 34 publications

(15 citation statements)

References 10 publications

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“…Other small series of patients with indirect CCFs have shown long-term obliteration of the fistula after treatment with radiosurgery in 75%-100% of patients. 3,17,28,53,64 Radiosurgery should not be used in emergency cases, as there is a latency of several months to years before complete obliteration of the CCF is accomplished. …”

Section: Radiosurgical Interventionmentioning

confidence: 99%

Carotid-cavernous fistulas

Ellis¹,

Goldstein²,

Connolly³

et al. 2012

FOC

276

326

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Carotid-cavernous fistulas (CCFs) are vascular shunts allowing blood to flow from the carotid artery into the cavernous sinus. The characteristic clinical features seen in patients with CCFs are the sequelae of hemodynamic dysfunction within the cavernous sinus. Once routinely treated with open surgical procedures, including carotid ligation or trapping and cavernous sinus exploration, endovascular therapy is now the treatment modality of choice in many cases. The authors provide a review of CCFs, detailing the current classification and clinical management of these lesions. Therapeutic options including conservative management, open surgery, endovascular intervention, and radiosurgical therapy are presented. The complications and treatment results as reported in the contemporary literature are also reviewed.

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Section: Radiosurgical Interventionmentioning

confidence: 99%

Carotid-cavernous fistulas

Ellis¹,

Goldstein²,

Connolly³

et al. 2012

FOC

276

326

View full text Add to dashboard Cite

show abstract

“…20 This may be a result of their proclivity to be small and low-flow. Although this would appear to make patients with DAVFs ideal candidates for radiosurgery, those with CVD have a much more malignant natural history and require expedient curative treatment via surgical or endovascular means.…”

Section: Discussionmentioning

confidence: 99%

“…Across our review, the study with the highest mean treatment volume (9.6 cm 3 ) demonstrated the lowest overall obliteration rate (41%). 9 On the other hand, the study of Onizuka et al 20 reported a 100% obliteration rate for 4 cavernous DAVFs with treatment volumes ranging from 0.8 to 1.8 cm 3 . Thus, in addition to cavernous location and lack of CVD, small DAVF size likely improves obliteration rates after SRS.…”

mentioning

confidence: 98%

Stereotactic radiosurgery for cerebral dural arteriovenous fistulas

Gross

Ropper²,

Popp³

et al. 2012

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Object Given the feasibility of curative surgical and endovascular therapy for cerebral dural arteriovenous fistulas (DAVFs), there is a relative paucity of radiosurgical series for these lesions as compared with their arteriovenous malformation counterparts. Methods The authors reviewed records of 56 patients with 70 cerebral DAVFs treated at their institution over the past 6 years. Ten DAVFs (14%) in 9 patients were treated with stereotactic radiosurgery (SRS), with follow-up obtained for 8 patients with 9 DAVFs. They combined their results with those obtained from a comprehensive review of the literature, focusing on obliteration rates, post-SRS hemorrhage rates, and other complications. Results In the authors' group of 9 DAVFs, angiographic obliteration was seen in 8 cases (89%), and no post-SRS hemorrhage or complications were observed after a mean follow-up of 2.9 years. Combining the results in these cases with data obtained from their review of the literature, they found 558 DAVFs treated with SRS across 14 series. The overall obliteration rate was 71%; transient worsening occurred in 9.1% of patients, permanent worsening in 2.4% (including 1 death, 0.2% of cases), and post-SRS hemorrhage occurred in 1.6% of cases (4.8% of those with cortical venous drainage [CVD]). The obliteration rate for cavernous DAVFs was 84%, whereas the rates for transversesigmoid and for tentorial DAVFs were 58% and 59%, respectively (adjusted p values, pcav,TS = 1.98 × 10−4, pcav,tent = 0.032). Obliteration rates were greater for DAVFs without CVD (80%, compared with 60% for those with CVD, p = 7.59 × 10−4). Both transient worsening and permanent worsening were less common in patients without CVD than in those with CVD (3.4% vs 7.3% for transient worsening and 0.9% vs 2.4% for permanent worsening). Conclusions Stereotactic radiosurgery with or without adjunctive embolization is an effective therapy for DAVFs that are not amenable to surgical or endovascular monotherapy. It is best suited for lesions without CVD and for cavernous DAVFs.

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“…[5][6][7][8][9][10] In AVM/DAVF radiosurgery, irradiation is delivered in a single fraction stereotactically to only the nidus of an AVM or fistula of a DAVF. Our current clinical practice of AVM/DAVF radiosurgery, integrated stereotactic imaging (MR imaging/MRA and x-ray digital subtraction angiography) is used for nidus/fistula delineation.…”

mentioning

confidence: 99%