| GammaKnife Surgery for Dural arteriovenous Fistula and Caroticocavernous Fistula :Primary or Second Treatment of Option |
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Min Park, Dong Gyu Shin, Tae Sik Gong, Hyo Joon Kim, Yong Woo Lee, Wooram Shin, Moo seong Kim, Seong Tae Kim, Sung Hwa Paeng, Se Young Pyo, Yang Won Kim |
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Department of Neurosurgery, Emergency Medicine, Inje University Busan Paik Hospital, Busan, Korea |
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| Abstract |
Objective
Sometimes surgery was associated with major morbidity because some locations were not easily accessible. Radiosurgery and endovascular embolization for dural arteriovenous fistulas (AVF) and caroticocavernous fistula (CCF) developled. We assess the role of Gammaknife radiosurgery (GKS) for dural arteriovenous fistulas (AVF) and caroticocavernous fistula (CCF) in role of primary or secondary treatment after embolization.
Material and Methods: Between 1994 and July 2011 we treated 15 patients with dural arteriovenous fistulas and caroticocavernous fistula (CCF). 2 patients were follow up lost. All patients were symptomatic. Before radiosurgery, embolization was performed in 7 patients. The mean patient age was 50 years (19-83). The mean radiation dose to the margin of the angiographically defined fistulas was 19.3Gy at the 50% or higher isodose line.
Results
We reviewed the results of clinical follow-up evalutions between 6 and 43 months after radiosurgical treatment. Follow up angiography or MR angiography underwent at least after treatment showed that 77.5% were totally obliterated. Total obliteration percentage of preGKS embolization to no embolization was 87.5 : 67. One 57-year-male dural AVF patient developed postradiosurgery complication(radiation associated glioblastoma) after 4 years later.
Conclusions
Radiosurgery and/or embolization can provide a useful treatment for dural arteriovenous fistuals and caroticocavernous fistula (CCF). Radiosurgery followed by embolization in selected patients is a safe and effective treatment in selected patients with symptomatic or high risk dural arteriovenous fistulas. |
| Key Words:
Radiosurgery, Embolization, Dural arteriovenous fistulas. |
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