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Stereotactic radiosurgery for intracranial dural arteriovenous fistulas: its clinical and angiographic perspectives

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Abstract

Background

To assess the efficacy of stereotactic radiosurgery (SRS) for intracranial dural arteriovenous fistulas (DAVFs), the authors retrospectively reviewed our 7-year experience. We evaluated the obliteration rate, improvement in clinical symptoms, and complications.

Methods

Thirty patients with DAVF underwent SRS using a Gamma Knife between 2009 and 2015. Twenty-three patients were treated with SRS alone, and seven patients underwent SRS for residual or recurrent DAVFs after embolization or surgery. Chemosis, diplopia, and pulsating tinnitus were the most common symptoms. Median target volume was 2.9 cm3 (range, 0.8–13.6 cm3), and median radiation dose to the target was 17 Gy (range, 12–20 Gy). Median follow-up period was 33 months (range, 6–82 months).

Results

At the last neuroimaging follow-up, DAVFs were totally obliterated in 23 patients (77%) and subtotally in 7 (23%). At the last clinical follow-up, 21 patients (70%) showed complete recovery, and 9 (30%) showed incomplete recovery in symptoms or signs. None experienced worsening symptoms or signs. Asymptomatic perilesional edema after SRS occurred in one patient (3%). Total obliteration rates after SRS were 43% at 1 year, 79% at 2 years, and 95% at 5 years. Improvement rates of neurological function after SRS were 12% at 1 month, 52% at 2 months, 72% at 3 months, and 96% at 6 months. A multivariate analysis revealed that Borden type 1 (p = 0.019, hazard ratio, 3.254, 95% confidence interval, 1.216–8.707) was significantly associated with symptom improvement.

Conclusions

SRS for intracranial DAVFs provided a high obliteration rate and a relatively low risk of radiation-induced complications. In selected benign cases without cortical venous drainage, SRS is a safe and effective treatment for symptom relief and fistula obliteration, even though the time course of improvement is longer than those of embolization and surgery.

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Authors and Affiliations

  1. Department of Neurosurgery, Kyungpook National University Hospital, 130 Dongduk-ro, Jung-gu, Daegu, 700-721, South Korea

    Seong-Hyun Park, Ki-Su Park, Dong-Hun Kang, Jeong-Hyun Hwang & Sung-Kyoo Hwang

  2. Department of Radiology, Kyungpook National University Hospital, Daegu, South Korea

    Dong-Hun Kang

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  1. Seong-Hyun Park
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  2. Ki-Su Park
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Correspondence to Seong-Hyun Park.

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Disclosure

No funding was received for this research. 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. 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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Comments

The article prepresents typical results after stereotactic radiosurgery of DAVFs and provides evidence against the opinion that, due to their specific flow characteristics, DAVFs cannot be treated radiosurgically. Furthermore it is interesting that patients experienced rather early symptom relief, even independent of the obliteration. Both the symptom relief and obliteration rate were particularly reliable in cavernous DAVFs with 94% of patients with ocular symptoms showing improvement within 6 months and for pulsatile tinnitus this obviously improved in all patients within 5 months.

Bodo Lippitz

Hamburg, Germany

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Park, SH., Park, KS., Kang, DH. et al. Stereotactic radiosurgery for intracranial dural arteriovenous fistulas: its clinical and angiographic perspectives. Acta Neurochir 159, 1093–1103 (2017). https://doi.org/10.1007/s00701-017-3177-1

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  • DOI: https://doi.org/10.1007/s00701-017-3177-1

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