The aim of this study was to assess the clinical efficacy of gamma knife surgery (GKS) in the treatment of dural arteriovenous shunts (DAVSs).
From a database of more than 1600 patients with intracranial arteriovenous shunts that had been treated with GKS, the authors retrospectively and prospectively identified 53 patients with 58 DAVSs from the period between 1978 and 2003. Four patients were lost to follow-up evaluation and were excluded from the series. Thus, this study is based on the remaining 49 patients with 52 DAVSs. Thirty-six of the shunts drained into the cortical venous system, either directly or indirectly, and 22 of these were associated with intracranial hemorrhage on patient presentation. The mean prescription radiation dose was 22 Gy (range 10–28 Gy).
All patients underwent a clinical follow-up examination. In 41 cases of DAVS a follow-up angiography study was performed. At the 2-year follow-up visit, 28 cases (68%) had angiographically proven obliteration of the shunt and in another 10 cases (24%) there was significant flow regression. Three shunts remained unchanged.
有一个我iate minor complication related to the administration of radiation. Furthermore, one patient had a radiation-induced complication 10 years after treatment, although she recovered completely. There was one posterior fossa bleed 2 months after radiosurgery; a hematoma, as well as a lesion, was evacuated, and the patient recovered uneventfully. A second patient had an asymptomatic occipital hemorrhage approximately 6 months postradiosurgery.
The clinical outcome after GKS was significantly better than that in patients with naturally progressing shunts (p < 0.01, chi-square test); figures on the latter have been reported previously.
Gamma knife surgery is an effective treatment for DAVSs, with a low risk of complications. Major disadvantages of this therapy include the time elapsed before obliteration and the possibility that not all shunts will be obliterated. Cortical venous drainage from a DAVS, a risk factor for intracranial hemorrhage, is therefore a relative contraindication. Consequently, GKS can be used in the treatment of both benign DAVSs with subjectively intolerable bruit and aggressive DAVSs not responsive to endovascular treatment or surgery.
AwadIA,,LittleJR,,AkarawiWP,&AhlJ:Intracranial dural arteriovenous malformations: factors predisposing to an aggressive neurological course.J Neurosurg72:839–850,1990
Barcia-SalorioJL,,HerandezG,,BrosetaJ,,Gonzalez-DarderJ,&CiudadJ:Radiosurgical treatment of carotid-cavernous fistula.Appl Neurophysiol45:520–522,1982
Barcia-SalorioJL,,SolerF,,BarciaJA,&HernandezG:立体定向放射治疗for the treatment of low-flow carotid-cavernous fistulae: results in a series of 25 cases.Stereotact Funct Neurosurg63:266–270,1994
BarrowDL,,SpectorRH,,BraunIF,,LandmanJA,,TindallSC,&TindallGT:Classification and treatment of spontaneous carotid-cavernous sinus fistulas.J Neurosurg62:248–256,1985
BordenJA,,WuJK,&ShucartWA:A proposed classification for spinal and cranial dural arteriovenous fistulous malformations and implications for treatment.J Neurosurg82:166–179,1995
BrownRDJr,,WiebersDO,&NicholsDA:Intracranial dural arteriovenous fistulae: angiographic predictors of intracranial hemorrhage and clinical outcome in nonsurgical patients.J Neurosurg81:531–538,1994
CastaigneP,,BoriesJ,,BrunetP,,CassanJL,,MeiningerV,&MerlandJJ:Fistules arterio-veineuses de la dure-mere, Etude clinique et radiologique de 13 observations.Ann Med Interne (Paris)126:813–817,1975
CastaigneP,,BoriesJ,,BrunetP,,MerlandJJ,&MeiningerV:Les fistules arterio-veineuses meningees pures a drainage veineux cortical.Rev Neurol (Paris)132:169–181,1976
CastaigneP,,LaplaneD,,DjindjianR,,BoriesJ,&AugustinP:Communication arterio-veineuse spontanee entre la carotide externe et le sinus caverneux.Rev Neurol (Paris)114:5–14,1966
ChandlerHCJr,&FriedmanWA:Successful radiosurgical treatment of a dural arteriovenous malformation: case report.开云体育app官方网站下载入口33:139–142,1993
CognardC,,GobinYP,,PierotL,,BaillyAL,,HoudartE,&CasascoA,et al.:Cerebral dural arteriovenous fistulas: clinical and angiographic correlation with a revised classification of venous drainage.Radiology194:671–680,1995
DaviesMA,,TerBruggeK,,WillinskyR,,CoyneT,,SalehJ,&WallaceMC:The validity of classification for the clinical presentation of intracranial dural arteriovenous fistulas.J Neurosurg85:830–837,1996
DaviesMA,,TerBruggeK,,WillinskyR,&WallaceC:The natural history and management of intracranial dural arteriovenous fistulae. Part 2: aggressive lesions.Intervent Neuroradiol3:303–311,1997
DjindjianR,,CophignonJ,,ComoyJ,,ReyJ,&HoudartR:Polymorphisme neuro-radiologique des fistules carotido-caverneuses.Neurochirurgie14:881–890,1968
DjindjianR,,MerlandJJ,&TheronJ:Super-selective Angiography of the External Carotid Artery.Berlin,Springer-Verlag,1978
DuffauH,,LopesM,,JanosevicV,,SichezJP,,FaillotT,&CapelleL,et al.:Early rebleeding from intracranial dural arteriovenous fistulas: report of 20 cases and review of the literature.J Neurosurg90:78–84,1999
FriedmanJA,,PollockBE,,NicholsDA,,GormanDA,,FooteRL,&StaffordSL:Results of combined stereotactic radiosurgery and transarterial embolization for dural arteriovenous fistulas of the transverse and sigmoid sinuses.J Neurosurg94:886–891,2001
GuoWY,,PanDH,,WuHM,,ChungWY,,ShiauCY,&WangLW,et al.:Radiosurgery as a treatment alternative for dural arteriovenous fistulas of the cavernous sinus.AJNR Am J Neuroradiol19:1081–1087,1998
HermanJM,,SpetzlerRF,,BedersonJB,,KurbatJM,&ZabramskiJM:Genesis of a dural arteriovenous malformation in a rat model.J Neurosurg83:539–545,1995
KarlssonB,,LaxI,&SödermanM:Can the probability for obliteration after radiosurgery of arteriovenous malformations be accurately predicted?.Int J Radiat Onc Biol Phys43:313–319,1999
KihlstromL,,GuoWY,,KarlssonB,,LindquistC,&LindqvistM:Magnetic resonance imaging of obliterated arteriovenous malformations up to 23 years after radiosurgery.J Neurosurg86:589–593,1997
KlischJ,,KubalekR,,ScheuflerKM,,ZirrgiebelU,,DrevsJ,&SchumacherM:Plasma vascular endothelial growth factor and serum soluble angiopoietin receptor sTIE-2 in patients with dural arteriovenous fistulas: a pilot study.Neuroradiology47:10–17,2005
LasjauniasP:Editorial comment on Davies’ papers. Angioarchitecture and natural history of dural arteriovenous shunts.Intervent Neuroradiol3:313–317,1997
LasjauniasP,,ChiuM,,ter BruggeK,,ToliaA,,HurthM,&BernsteinM:Neurological manifestations of intracranial dural arteriovenous malformations.J Neurosurg64:724–730,1986
LasjauniasP,,HalimiP,,Lopez-IborL,,SichezJP,,HurthM,&De TriboletN:Traitement endovasculaire des malformations vasculaires durales (MVD) pures “spontanees”. Revue de 23 cas explores et traites entre mai 1980 et octobre 1983.Neurochirurgie30:207–223,1984
LinkMJ,,CoffeyRJ,,NicholsDA,&GormanDA:The role of radio-surgery and particulate embolization in the treatment of dural arteriovenous fistulas.J Neurosurg84:804–809,1996
MalikGM,,PearceJE,,AusmanJI,&MehtaB:Dural arteriovenous malformations and intracranial hemorrhage.开云体育app官方网站下载入口15:332–339,1984
MaruyamaK,,ShinM,,KuritaH,,TagoM,&KirinoT:立体定向放射治疗for dural arteriovenous fistula involving the superior sagittal sinus. Case report.J Neurosurg97:5 Suppl481–483,2002
MederJF,,OppenheimC,,BlustajnJ,,NatafF,,MerienneL,&LefkoupolosD,et al.:Cerebral arteriovenous malformations: the value of radiologic parameters in predicting response to radiosurgery.AJNR Am J Neuroradiol18:1473–1483,1997
NewtonTH,&CronqvistS:Involvement of dural arteries in intracranial arteriovenous malformations.Radiology93:1071–1078,1969
OnizukaM,,MoriK,,TakahashiN,,KawaharaI,,HiuT,&TodaK,et al.:Gamma knife surgery for the treatment of spontaneous dural carotid-cavernous fistulas.神经医学Chir(东京)43:477–483,2003
PanDH,,ChungWY,,GuoWY,,WuHM,,LiuKD,&ShiauCY,et al.:立体定向放射治疗for the treatment of dural arteriovenous fistulas involving the transverse-sigmoid sinus.J Neurosurg96:823–829,2002
PollockBE,,NicholsDA,,GarrityJA,,GormanDA,&StaffordSL:立体定向放射治疗and particulate embolization for cavernous sinus dural arteriovenous fistulae.开云体育app官方网站下载入口45:459–467,1999
RothbartD,,AwadIA,,LeeJ,,KimJ,,HarbaughR,&CriscuoloGR:Expression of angiogenic factors and structural proteins in central nervous system vascular malformations.开云体育app官方网站下载入口38:915–925,1996
SarmaD,&TerBruggeK:Management of intracranial dural arteriovenous shunts in adults.Eur J Radiol46:206–220,2003
SchneiderBF,,EberhardDA,&SteinerLE:Histopathology of arteriovenous malformations after gamma knife radiosurgery.J Neurosurg87:352–357,1997
ShinM,,KuritaH,,TagoM,&KirinoT:立体定向放射治疗for tentorial dural arteriovenous fistulae draining into the vein of Galen: report of two cases.开云体育app官方网站下载入口46:730–734,2000
TeradaT,,HigashidaRT,,HalbachVV,,DowdCF,,TsuuraM,&KomaiN,et al.:Development of acquired arteriovenous fistulas in rats due to venous hypertension.J Neurosurg80:884–889,1994
TeradaT,,TsuuraM,,KomaiN,,HigashidaRT,,HalbachVV,&DowdCF,et al.:The role of angiogenic factor bFGF in the development of dural AVFs.Acta Neurochir (Wien)138:877–883,1996
TirakotaiW,,BianLG,,BertalanffyH,,SiegfriedB,&SureU:Immunohistochemical study in dural arteriovenous fistula and possible role of ephrin-B2 for development of dural arteriovenous fistula.下巴地中海J(英格兰)117:1815–1820,2004
UranishiR,,NakaseH,&SakakiT:Expression of angiogenic growth factors in dural arteriovenous fistula.J Neurosurg91:781–786,1999
van DijkJM,&TerBruggeKG:Dural arteriovenous fistulas.J Neurosurg97:1486–1487,2002
van DijkJM,,terBruggeKG,,WillinskyRA,&WallaceMC:Clinical course of cranial dural arteriovenous fistulas with long-term persistent cortical venous reflux.Stroke33:1233–1236,2002
van DijkJM,,TerBruggeKG,,WillinskyRA,&WallaceMC:Selective disconnection of cortical venous reflux as treatment for cranial dural arteriovenous fistulas.J Neurosurg101:31–35,2004
WillinskyR,,GoyalM,,terBruggeK,&MontaneraW:Tortuous, engorged pial veins in intracranial dural arteriovenous fistulas: correlations with presentation, location, and MR findings in 122 patients.AJNR Am J Neuroradiol20:1031–1036,1999
All Time | Past Year | Past 30 Days | |
---|---|---|---|
Abstract Views | 3272 | 1807 | 35 |
Full Text Views | 192 | 10 | 1 |
PDF Downloads | 186 | 22 | 2 |
EPUB Downloads | 0 | 0 | 0 |