Gamma Knife surgery for low-flow cavernous sinus dural arteriovenous fistulas.
OBJECTIVE
The purpose of this study was to assess the efficacy of Gamma Knife surgery (GKS) for treating cavernous sinus dural arteriovenous fistulas (CSDAVFs).


METHODS
Of the 4123 GKSs performed between May 1992 and March 2009, 890 procedures were undertaken to treat vascular lesions. In 24 cases, the vascular lesion that was treated was a dural arteriovenous fistula, and in 6 of these cases, the lesion involved the cavernous sinus. One of these 6 cases was lost to follow-up, leaving the other 5 cases (4 women and 1 man) to comprise the subjects of this study. All 5 patients had more than 1 ocular symptom, such as ptosis, chemosis, proptosis, and extraocular movement palsy. In all patients, CSDAVF was confirmed by conventional angiography. Three patients were treated by GKS alone and 2 patients were treated by GKS combined with transarterial embolization. The median follow-up period after GKS in these 5 cases was 30 months (range 9-59 months).


RESULTS
All patients experienced clinical improvement, and their improvement in ocular symptoms was noticed at a mean of 17.6 weeks after GKS (range 4-24 weeks). Two patients received embolization prior to GKS but did not display improvement in ocular symptoms. An average of 20 weeks (range 12-24 weeks) was needed for complete improvement in clinical symptoms. There were no treatment-related complications during the follow-up period.


CONCLUSIONS
Gamma Knife surgery should be considered as a primary, combined, or additional treatment option for CSDAVF in selected cases, such as when the lesion is a low-flow shunt without cortical venous drainage. For those selected cases, GKS alone may suffice as the primary treatment method when combined with close monitoring of ocular symptoms and intraocular pressure.
Department of Neurosurgery, Wonju Christian Hospital, Yonsei University, Wonju Medical College, Wonju, Republic of Korea.
Hyun Ho
HH
Jung
Jong Hee
JH
Chang
Kum
K
Whang
Jin Soo
JS
Pyen
Jin Woo
JW
Chang
Yong Gou
YG
Park
D000368:Aged; D002426:Cavernous Sinus / Q000000981:diagnostic imaging / Q000601:surgery*; D020785:Central Nervous System Vascular Malformations / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D016634:Radiosurgery / Q000295:instrumentation*; D016896:Treatment Outcome