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Sinovenous outflow in lateral sinus dural arteriovenous fistulas after stereotactic radiosurgery: a retrospective longitudinal imaging study

  • Original Article - Vascular Neurosurgery - Other
  • Published:
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Abstract

Purpose

To investigate sinovenous outflow restriction (SOR) in lateral sinus dural arteriovenous fistulas (LSDAVFs) after Gamma Knife radiosurgery (GKRS) and its association with complete obliteration.

Methods

We retrospectively (1995–2019) enrolled 39 patients with LSDAVFs who had undergone GKRS alone and evaluated their angiography and magnetic resonance imaging (MRI) before and after GKRS. The LS conduits ipsilateral and contralateral to the DAVFs were scored using a 5-point scoring system, with scores ranging from 0 (total occlusion) to 4 (fully patent). SOR was defined by a conduit score < 2. Demographics, imaging features, and outcomes were compared between patients with and without ipsilateral SOR after GKRS. Logistic regression analysis was performed to estimate the odds ratio (OR) for obliteration with the imaging findings.

Results

After a median angiographic follow-up of 28 months for the 39 patients, the ipsilateral LS became more restrictive (median conduit score before and after GKRS: 2 vs. 1, p = .011). Twenty-one patients with ipsilateral SOR after GKRS had a significantly lower obliteration rate (52.4% vs. 94.4%, p = .005) than those without SOR. Follow-up SOR was independently associated with a lower obliteration rate (OR 0.05, p = .017) after adjustment for age, cortical venous reflux, and absent sinus flow void on MRI.

Conclusion

This study demonstrates a restrictive change of outflow in LSDAVFs after GKRS and a lower obliteration rate in patients with SOR. Follow-up imaging for SOR may help predict outcomes of these patients.

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Abbreviations

SOR:

Sinovenous outflow restriction

LSDAVF:

Lateral sinus dural arteriovenous fistula

GKRS:

Gamma Knife radiosurgery

OR:

Odds ratio

CVR:

Cortical venous reflux

DSA:

Quantitative digital subtraction angiography

MRI:

Magnetic resonance imaging

PPP:

Pseudo-phlebitic pattern

ONS:

Optic nerve sheath

RIC:

Radiation-induced change

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Acknowledgements

The authors would like to thank Hsin-Yi Huang (Biostatistics Task Force, Taipei Veterans General Hospital) for providing statistical analysis assistance. This manuscript was edited by Wallace Academic Editing.

Funding

This study was funded by Taipei Veterans General Hospital (grant number: V110C-056) and Taiwan’s Ministry of Science and Technology (grant number: MOST-109–2628-B-010–014-MY2).

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Authors and Affiliations

  1. Department of Radiology, Taipei Hospital, Ministry of Health and Welfare, New Taipei, Taiwan

    Yong-Sin Hu

  2. School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan

    Yong-Sin Hu, Cheng-Chia Lee, Chia-An Wu, Hsiu-Mei Wu, Huai-Che Yang, Wan-Yuo Guo, Chao-Bao Luo, Kang-Du Liu, Wen-Yuh Chung & Chung-Jung Lin

  3. Department of Radiology, Taipei Veterans General Hospital, No. 201, Shipai Rd., Sec. 2, Beitou District, Taipei, 112, Taiwan

    Yong-Sin Hu, Chia-An Wu, Hsiu-Mei Wu, Wan-Yuo Guo, Chao-Bao Luo & Chung-Jung Lin

  4. Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan

    Cheng-Chia Lee, Huai-Che Yang, Kang-Du Liu & Wen-Yuh Chung

  5. Department of Radiology, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan

    Chia-An Wu

  6. Department of Neurosurgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan

    Wen-Yuh Chung

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  1. Yong-Sin Hu
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Correspondence to Chung-Jung Lin.

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All procedures in studies involving human participants were performed in accordance with the ethical standards of the institutional and/or national research committee (Department of Research Programs Walter Reed National Military Medical Center Institutional Review Board) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study, formal consent was not required.

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Hu, YS., Lee, CC., Wu, CA. et al. Sinovenous outflow in lateral sinus dural arteriovenous fistulas after stereotactic radiosurgery: a retrospective longitudinal imaging study. Acta Neurochir 164, 2409–2418 (2022). https://doi.org/10.1007/s00701-022-05310-x

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