Multidisciplinary treatment of cavernous sinus dural arteriovenous fistulae with radiosurgery and embolization.
OBJECTIVE
With the advent of interventional neuroradiology and stereotactic radiosurgery, dural arteriovenous fistulae are less often managed with open surgery. We evaluated the outcome of dural arteriovenous fistulae of the cavernous sinus treated with a combination of radiosurgery and embolization.


METHODS
Twenty dural arteriovenous fistulae located in the cavernous sinus were enrolled in our study. Fifteen patients received X-knife radiosurgery alone and 5 also required embolization, one before radiosurgery and 4 after radiosurgery. The mean volume of the lesions was 2.8 ml (range 0.2-12.6), the corresponding radiation volume was 6.5 ml (range 0.6-24.6), and the conformity index was 2.9 (range 1.8-5.3). The mean peripheral and maximum radiation dose was 17.8 Gy (range 17-20) and 28.3 Gy (range 19-37) Gy, respectively. The clinical and imaging data were analyzed.


RESULTS
The mean follow up period was 29 months (23-39). Seventy-five percent (15/20) of patients receiving radiosurgery alone achieved a symptomatic cure and with additional embolization 90% (18/20) were cured. All patients achieved cure on imaging after radiosurgery alone or in combination with embolization. Abnormal imaging findings were observed in two patients after treatment, one had an intracerebral hemorrhage and the other radiation edema, but both were asymptomatic.


CONCLUSIONS
With multidisciplinary treatment with combined radiosurgery and embolization, satisfactory results can be achieved for dural arteriovenous fistulae with a low complication rate. In patients with mild symptoms, radiosurgery is the initial treatment option. Embolization should be performed in patients with severe symptoms or who have failed radiosurgery.
Pan
Hung-Chuan
HC
Departments of Neurosurgery and General Hospital, Veterans Hospital Taichung,Chung-Hwa College of Medicine Technology, Tainan, Taiwan.
Sun
Ming-Hsi
MH
Yang
Dar-Yu
DY
Wang
Yeou-Chih
YC
Lee
Shinh-Dung
SD
Chen
Wen-Hsien
WH
Chen
Chi-Chang Clayton
CC
D000328:Adult; D000368:Aged; D002426:Cavernous Sinus / Q000528:radiation effects* / Q000601:surgery*; D020785:Central Nervous System Vascular Malformations / Q000628:therapy*; D002533:Cerebral Angiography / Q000379:methods; D004621:Embolization, Therapeutic; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008875:Middle Aged; D016634:Radiosurgery; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D013238:Stereotaxic Techniques; D016896:Treatment Outcome