Stereotactic radiosurgery and particulate embolization for cavernous sinus dural arteriovenous fistulae.
OBJECTIVE
To evaluate the safety and efficacy of stereotactic radiosurgery, either with or without transarterial embolization, in the treatment of patients with dural arteriovenous fistulae (DAVFs) of the cavernous sinus.


METHODS
We reviewed the findings, from a prospectively established database, for 20 patients with cavernous sinus DAVFs who were treated with either radiosurgery alone (n = 7) or radiosurgery and transarterial embolization (n = 13) in a 7-year period. The median follow-up period after radiosurgery was 36 months (range, 4-59 mo).


RESULTS
Nineteen of 20 patients (95%) experienced improvement of their clinical symptoms. Fourteen of 15 patients (93%) experienced either total (n = 13) or nearly total (n = 1) obliteration of their DAVFs, as documented by angiography performed a median of 12 months after radiosurgery. No patient experienced a recurrence of symptoms after angiography showed DAVF obliteration. Two patients developed new neurological deficits after embolization procedures. One patient exhibited temporary aphasia secondary to a venous infarction; another patient exhibited permanent VIth cranial nerve weakness related to acute cavernous sinus thrombosis. Two patients experienced recurrent symptoms and underwent repeat transarterial embolization at 7 and 12 months; both patients achieved clinical and angiographic cures (5 and 10 mo later, respectively). One patient experienced recurrent visual symptoms and underwent transvenous embolization 4 months after radiosurgery.


CONCLUSIONS
Staged radiosurgery and transarterial embolization provided both rapid symptom relief and long-term cures for patients with cavernous sinus DAVFs. Radiosurgery alone was effective for patients with DAVFs whose arterial supply was not accessible via a transarterial approach, although the time course of symptom improvement was longer, compared with patients who also underwent embolization.
Pollock
B E
BE
Department of Neurological Surgery, Mayo Clinic and Foundation, Rochester, Minnesota 55905, USA.
Nichols
D A
DA
Garrity
J A
JA
Gorman
D A
DA
Stafford
S L
SL
D000328:Adult; D000368:Aged; D001164:Arteriovenous Fistula / Q000175:diagnosis / Q000601:surgery* / Q000628:therapy*; D002339:Carotid Arteries / Q000000981:diagnostic imaging; D002426:Cavernous Sinus; D003131:Combined Modality Therapy; D019992:Databases as Topic; D004388:Dura Mater / Q000098:blood supply*; D004621:Embolization, Therapeutic / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000175:diagnosis / Q000601:surgery* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D016634:Radiosurgery / Q000009:adverse effects; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome