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The efficacy of gamma knife radiosurgery alone as a primary treatment for intracranial dural arteriovenous fistulas

  • Clinical Article - Vascular
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Abstract

Background

The application of gamma knife radiosurgery (GKRS) alone has been expanded for dural arteriovenous fistulas (DAVFs). However, a standardized protocol delineating the appropriate circumstances for GKRS alone in cases of DAVF has yet to be determined. The purpose of this study was to report a single center’s treatment algorithm for GKRS alone as a primary treatment for intracranial DAVFs and assess related clinical and radiological data.

Method

Among 31 DAVF patients treated according to our institute’s treatment algorithm between February 2009 and November 2014, 20 patients underwent GKRS alone. DAVF patients treated with GKRS alone fell in two main subgroups: DAVF patients without cortical venous reflux (CVR) but with symptoms (n = 8) and DAVF patients with CVR but without a high bleeding risk (defined as CVR with aggressive symptoms including hemorrhage or non-hemorrhagic neurological deficit, n = 11). One DAVF patient with a high bleeding risk had GKRS alone because of difficult endovascular access. Mean radiation volume was 4.8 cc (range, 0.7–14.2 cc), and mean maximal dose was 33.5 Gy (range, 28–38 Gy).

Results

At mean follow-up of 29.1 months (range, 8–69 months), radiological findings demonstrated complete cures in 18 patients (90 %) and subtotal cures in 2 patients (10 %). One patient had a transient complication, but no neurologic sign. All symptomatic patients showed complete resolution.

Conclusions

Our treatment algorithm showed GKRS alone may serve as a primary treatment for patients with DAVFs regardless of location and presence of CVR, unless there is a high bleeding risk. However, a multicenter, prospective study is necessary to generalize our treatment algorithm.

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Acknowledgments

We thank Wade Martin of Medical Research International for his critical review of this manuscript.

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Authors and Affiliations

  1. Department of Neurosurgery, Chung-Ang University College of Medicine, Seoul, South Korea

    Ki-Su Park

  2. Department of Neurosurgery, Kyungpook National University School of Medicine, Daegu, South Korea

    Seong-Hyun Park

  3. Department of Radiology and Neurosurgery, Kyungpook National University School of Medicine, 101 Dongin-dong 2 Ga, Jung-gu, Daegu, 700-422, Republic of Korea

    Dong-Hun Kang

  4. Department of Radiology, Kyungpook National University School of Medicine, Daegu, South Korea

    Yong-Sun Kim

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  1. Ki-Su Park
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Correspondence to Dong-Hun Kang.

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No funding was received for this research.

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All authors certify that they have no affiliations　with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers' bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

For this type of study formal consent is not required.

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Informed consent was obtained from all individual participants included in the study. Additional informed consent was obtained from all individual participants for whom identifying information is included in this article.

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Park, KS., Kang, DH., Park, SH. et al. The efficacy of gamma knife radiosurgery alone as a primary treatment for intracranial dural arteriovenous fistulas. Acta Neurochir 158, 821–828 (2016). https://doi.org/10.1007/s00701-016-2720-9

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  • DOI: https://doi.org/10.1007/s00701-016-2720-9

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