Stereotactic Radiosurgery for Dural Arteriovenous Fistulas Involving the Transverse-Sigmoid Sinus : A Single Center Experience and Review of the Literatures

Baek, Hong-Gyu; Park, Seong-Hyun; Park, Ki-Su; Kang, Dong-Hun; Hwang, Jeong-Hyun; Hwang, Sung-Kyoo

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자료유형: 학술저널

저자정보: Baek, Hong-Gyu (Department of Neurosurgery, School of Medicine, Kyungpook National University) Park, Seong-Hyun (Department of Neurosurgery, School of Medicine, Kyungpook National University) Park, Ki-Su (Department of Neurosurgery, School of Medicine, Kyungpook National University) Kang, Dong-Hun (Department of Neurosurgery, School of Medicine, Kyungpook National University) Hwang, Jeong-Hyun (Department of Neurosurgery, School of Medicine, Kyungpook National University) Hwang, Sung-Kyoo (Department of Neurosurgery, School of Medicine, Kyungpook National University)

저널정보: 대한신경외과학회 대한신경외과학회지 대한신경외과학회지 제62권 제4호

발행연도: 2019.1

수록면: 458 - 466 (9page)

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Objective : We retrospectively assessed the efficacy of stereotactic radiosurgery (SRS) for dural arteriovenous fistulas (DAVFs) involving the transverse-sigmoid sinus and analyzed the angiographic and clinical results with our 8-year experience. Methods : Nine patients with intracranial DAVFs involving the transverse-sigmoid sinus underwent SRS using a Gamma $Knife^{(R)}$ (Elekta Inc., Atlanta, GA, USA) between 2009 and 2016. Five patients underwent SRS for residual DAVFs after embolization and four patients were treated with SRS alone. The median target volume was $1.9cm^3$ (range, 0.8-14.2) and the median radiation dose of the target was 17 Gy (range, 16-20). The median follow-up period was 37 months (range, 7-81). Results : Pulsating tinnitus (33%) was the most common symptom. DAVFs were completely obliterated in four patients (44%) and subtotally obliterated in five (56%). Six patients (67%) showed complete recovery of symptoms or signs, and three (33%) showed incomplete recovery. One patient experienced a recurrent seizure. Adverse radiation effects after SRS occurred in one patient (11%). The total obliteration rates after SRS were 16.7%, 37.5%, and 68.7% at 1, 2, and 3 years, respectively. The median interval from SRS to total obliteration of the fistula was 31 months (range, 12-38). The rates at which the symptoms started to improve were 40% at 1 month and 80% at 2 months after SRS. Symptoms started to improve at a median of 5 weeks after SRS (range, 3-21). Conclusion : SRS with or without embolization is a safe and effective treatment to relieve symptoms and obliterate DAVFs on the transverse-sigmoid sinus.

#Central nervous system vascular malformations #Radiosurgery #Transverse sinuses

참고문헌 (16)

참고문헌 신청

Borden JA / 1995 / A proposed classification for spinal and cranial dural arteriovenous fistulous malformations and implications for treatment / J Neurosurg 82:166~179

Chen CJ / 2015 / Stereotactic radiosurgery for intracranial dural arteriovenous fistulas: a systematic review / J Neurosurg 122:353~362

Chung SJ / 2002 / Intracranial dural arteriovenous fistulas: analysis of 60 patients / Cerebrovasc Dis 13:79~88

Cifarelli CP / 2010 / Gamma knife radiosurgery for dural arteriovenous fistulas / Neurosurgery 67:1230~1235

Cognard C / 1995 / Cerebral dural arteriovenous fistulas: clinical and angiographic correlation with a revised classification of venous drainage / Radiology 194:671~680

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