Multidisciplinary treatment of cavernous sinus dural arteriovenous fistulae with radiosurgery and embolization

Pan, Hung-Chuan; Sun, Ming-Hsi; Yang, Dar-Yu; Wang, Yeou-Chih; Lee, Shinh-Dung; Chen, Wen-Hsien; Chen, Chi-Chang Clayton

doi:10.1016/j.jocn.2004.09.026

Cited by 16 publications

(26 citation statements)

References 18 publications

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“…7,12,22,23,35,39,51 Although endovascular embolization may provide immediate symptomatic relief and reduction of hemorrhage risk, the treatment may not afford longterm cure in cases of subtotal obliteration or delayed recanalization. 24 Therefore, SRS serves as a complementary treatment by potentially increasing the likelihood of permanent DAVF occlusion.…”

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confidence: 99%

Stereotactic radiosurgery for intracranial dural arteriovenous fistulas: a systematic review

Chen¹,

Lee

Ding³

et al. 2015

JNS

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C urrent treatment strategies for intracranial dural arteriovenous fistulas (DAVFs) include microsurgical ligation, transarterial or transvenous embolization, stereotactic radiosurgery (SRS), and various combinations of these therapeutic options. Endovascular therapy, most commonly performed via transvenous routes, has become the preferred treatment approach for DAVFs. 27,44,48 Due to the immediate obliteration that can be achieved with endovascular or surgical occlusion, SRS is typically reserved for lesions that cannot be obliterated with endovascular or surgical approaches, or for patients who pose a high surgical risk due to medical comorbidities. Therefore, published SRS series for DAVFs remain relatively few and comprise mostly retrospective, single-center studies.In this systematic review, we evaluate the obliteration rate of DAVFs in patients treated with SRS. We also compare obliteration rates between cavernous sinus (CS) and noncavernous sinus (NCS) DAVFs, and between DAVFs with and without cortical venous drainage (CVD), by using available data in the literature. Methods inclusion CriteriaIn our attempt to balance between the largest possible patient population and a relatively homogeneous cohort, the following inclusion criteria for this systematic review were devised: 1) the study must contain at least 5 patients abbreviatioNs AVM = arteriovenous malformation; CS = cavernous sinus; CVD = cortical venous drainage; DAVF = dural arteriovenous fistula; GKS = Gamma Knife surgery; LINAC = linear accelerator; NCS = noncavernous sinus; SRS = stereotactic radiosurgery; TSS = transverse and sigmoid sinus. obJeCt The goal of this study was to evaluate the obliteration rate of intracranial dural arteriovenous fistulas (DAVFs) in patients treated with stereotactic radiosurgery (SRS), and to compare obliteration rates between cavernous sinus (CS) and noncavernous sinus (NCS) DAVFs, and between DAVFs with and without cortical venous drainage (CVD). Methods A systematic literature review was performed using PubMed. The CS DAVFs and the NCS DAVFs were categorized using the Barrow and Borden classification systems, respectively. The DAVFs were also categorized by location and by the presence of CVD. Statistical analyses of pooled data were conducted to assess complete obliteration rates in CS and NCS DAVFs, and in DAVFs with and without CVD. results Nineteen studies were included, comprising 729 patients harboring 743 DAVFs treated with SRS. The mean obliteration rate was 63% (95% CI 52.4%-73.6%). Complete obliteration for CS and NCS DAVFs was achieved in 73% and 58% of patients, respectively. No significant difference in obliteration rates between CS and NCS DAVFs was found (OR 1.72, 95% CI 0.66-4.46; p = 0.27). Complete obliteration in DAVFs with and without CVD was observed in 56% and 75% of patients, respectively. A significantly higher obliteration rate was observed in DAVFs without CVD compared with DAVFs with CVD (OR 2.37, 95% CI 1.07-5.28; p = 0.03). CoNClusioNs Treatment with SRS offers favorable rates of D...

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confidence: 99%

Stereotactic radiosurgery for intracranial dural arteriovenous fistulas: a systematic review

Chen¹,

Lee

Ding³

et al. 2015

JNS

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“…The evolving technique of endovascular embolism has been used both in combination with surgical treatment [1219] and alone as a less invasive option. Recently, GKRS has been used to treat dural AVFs in combination with endovascular embolization [122021]. Many have reported that GKRS alone is effective in treating dural AVFs, especially for controlling symptoms, and our experience showed the same results [6922].…”

Section: Discussionmentioning

confidence: 56%

Treating intracranial dural arteriovenous fistulas with gamma knife radiosurgery: A single-center experience

et al. 2017

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Objective:We evaluated the effectiveness and safety of gamma knife radiosurgery (GKRS) for the treatment of intracranial dural arteriovenous fistulas (dural AVFs) over the past 10 years.Materials and Methods:The records of 21 patients diagnosed with dural AVFs between 2004 and 2014 and treated with GKRS were reviewed retrospectively. Complete obliteration (CO) was defined as total symptom relief plus confirmation through magnetic resonance imaging or conventional angiography.Results:The median follow-up was 70.5 months (range 3–136 months). Five patients underwent embolization (2 after GKRS). One patient underwent GKRS twice. The CO rate was 47%, and partial to CO rate was 88%. The complete symptom resolution rate was 77%, and all patients achieved partial to complete symptom resolution. The CO rates for Borden Type I and Type II/III dural AVFs were 66.7% and 25% (P = 0.153), respectively, and complete symptom-free rates were 76.9% and 75.0% (P = 1.000%), respectively. The median duration between initial GKRS and complete symptom resolution was 14.3 months. The median treatment to image-free durations for Borden Type I and Type II/III dural AVFs were 25.9 and 60.4 months (P = 0.028), respectively, and treatment to symptom-free durations were 10.6 and 36.7 months (P = 0.103), respectively. One patient had a recurrent hemorrhage. Two patients experienced brain edema after stereotactic radiosurgery and one patient experienced cystic formation after GKRS. The morbidity rate was 19% (four patients) and there was no mortality.Conclusion:Treatment with GKRS for dural AVFs offers a favorable rate of obliteration. Patients with dural AVFs that are refractory or not amenable to endovascular or surgical therapy may be safely and effectively treated using GKRS.

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“…Pan and Guo reported successful obliteration rates of 70 % and 90 % , respectively, using gamma knife radiosurgery for transverse-sigmoid sinus and cavernous sinus dural AVFs [17,18] . In a previous report from our group, either stereotactic radiosurgery alone or combined radiosurgery and transarterial embolization yielded excellent obliteration for CCFs [19] . The treatment choice of embolization, stereotactic radiosurgery, or a combination of the two must be made according to the patient ' s clinical presentation and neuro-imaging (e. g., cerebral angiogram, MRI / A, CT / A) fi ndings.…”

Section: Introductionmentioning

confidence: 62%

“…In our previous report, we treated cavernous sinus dAVFs with the combined treatment of the transarterial embolization and radiosurgery based on the severity of clinical presentation and image fi ndings. Ninety percent of patients obtained total obliteration via radiosurgery alone and another 10 % of the fi stulae were obliterated with radiosurgery and transarterial embolization [19] . Not all patients required combined treatment; Guo et al reported 80 % obliteration of dAVFs using radiosurgery alone [17] .…”

Section: Treatment Of Dural Arteriovenous Fi Stulaementioning

confidence: 99%

Minimally Invasive Approaches to Treating Chemosis of the Eyes from Unusual Dural Arteriovenous Fistulae

Pan¹,

Sun²,

Chen³

et al. 2009

Minim Invasive Neurosurg

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Chemosis of the eyes is usually attributed to carotid cavernous sinus dural arteriovenous fistulae. Herein, we reviewed unusual cases in which chemosis of the eyes originated from dural ateriovenous fistulae (dAVFs) that were distinctly different from carotid cavernous sinus fistulae. Cases in which ocular symptoms were related to increased intracranial pressure either due to sinus thrombosis or cortical venous drainage without involvement of superior or inferior ophthalmic veins were excluded in this review. Several different types of dural AVFs were associated with chemosis, and these included dAVFs harboring a feeding artery from branches of the external carotid artery directly draining to the superior ophthalmic vein or cavernous sinus via the superior petrous sinus, posterior fossa dAVFs draining via the inferior petrous sinus and cavernous sinus to the ophthalmic vein, a fistula between the ophthalmic artery or branches of the internal carotid artery and inferior ophthalmic vein, or tentorial fistula with a drainage vein to the cavernous sinus via the vein of Galen. This study reviews the symptomatology, treatment options, and cerebrovascular abnormalities observed for these unusual dAVF's with chemosis.

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Multidisciplinary treatment of cavernous sinus dural arteriovenous fistulae with radiosurgery and embolization

Cited by 16 publications

References 18 publications

Stereotactic radiosurgery for intracranial dural arteriovenous fistulas: a systematic review

Stereotactic radiosurgery for intracranial dural arteriovenous fistulas: a systematic review

Treating intracranial dural arteriovenous fistulas with gamma knife radiosurgery: A single-center experience

Minimally Invasive Approaches to Treating Chemosis of the Eyes from Unusual Dural Arteriovenous Fistulae

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