title: The efficacy of gamma knife radiosurgery alone as a primary treatment for intracranial dural arteriovenous fistulas.
abstract: BACKGROUND
  The application of gamma knife radiosurgery (GKRS) alone has been expanded for dural arteriovenous fistulas (DAVFs). However, a standardized protocol delineating the appropriate circumstances for GKRS alone in cases of DAVF has yet to be determined. The purpose of this study was to report a single center's treatment algorithm for GKRS alone as a primary treatment for intracranial DAVFs and assess related clinical and radiological data.
  
  
  METHODS
  Among 31 DAVF patients treated according to our institute's treatment algorithm between February 2009 and November 2014, 20 patients underwent GKRS alone. DAVF patients treated with GKRS alone fell in two main subgroups: DAVF patients without cortical venous reflux (CVR) but with symptoms (n = 8) and DAVF patients with CVR but without a high bleeding risk (defined as CVR with aggressive symptoms including hemorrhage or non-hemorrhagic neurological deficit, n = 11). One DAVF patient with a high bleeding risk had GKRS alone because of difficult endovascular access. Mean radiation volume was 4.8 cc (range, 0.7-14.2 cc), and mean maximal dose was 33.5 Gy (range, 28-38 Gy).
  
  
  RESULTS
  At mean follow-up of 29.1 months (range, 8-69 months), radiological findings demonstrated complete cures in 18 patients (90 %) and subtotal cures in 2 patients (10 %). One patient had a transient complication, but no neurologic sign. All symptomatic patients showed complete resolution.
  
  
  CONCLUSIONS
  Our treatment algorithm showed GKRS alone may serve as a primary treatment for patients with DAVFs regardless of location and presence of CVR, unless there is a high bleeding risk. However, a multicenter, prospective study is necessary to generalize our treatment algorithm.
authors: Department of Neurosurgery, Chung-Ang University College of Medicine, Seoul, South Korea.
authors: Ki-Su
authors: KS
authors: Park
authors: Department of Radiology and Neurosurgery, Kyungpook National University School of Medicine, 101 Dongin-dong 2 Ga, Jung-gu, Daegu, 700-422, Republic of Korea. kdhdock@gmail.com.
authors: Dong-Hun
authors: DH
authors: Kang
authors: Department of Neurosurgery, Kyungpook National University School of Medicine, Daegu, South Korea.
authors: Seong-Hyun
authors: SH
authors: Park
authors: Department of Radiology, Kyungpook National University School of Medicine, Daegu, South Korea.
authors: Yong-Sun
authors: YS
authors: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020785:Central Nervous System Vascular Malformations / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016634:Radiosurgery / Q000295:instrumentation* / Q000379:methods; D016896:Treatment Outcome
keywords: Arteriovenous fistula; Dural; Gamma knife radiosurgery; Outcome; Stereotactic radiosurgery