BACKGROUND: The current management of intracranial dural arteriovenous fistulas (dAVFs) incorporates a multimodal approach involving microneurosurgery, endovascular embolization, and radiosurgery. OBJECTIVE: To explore the role of Gamma Knife radiosurgery for dAVFs. METHODS: The series includes patients with dAVFs who had Gamma Knife radiosurgery at the University of Virginia Medical Center between 1989 and 2005 with clinical follow-up through 2008. Medical records were reviewed to obtain clinical history, demographic data, and dosimetry. Radiographic records provided the location and anatomy of the dAVFs. Follow-up angiography was performed 2 to 3 years after treatment, with cure defined as complete obliteration of fistulous flow. Follow-up for clinical symptomology and quality of life was obtained from direct patient and primary physician questionnaires. RESULTS: Fifty-five patients underwent Gamma Knife radiosurgery for dAVFs during the study period. Twenty patients (36%) presented with intracranial hemorrhage before radiosurgery. Gamma Knife radiosurgery was preceded by craniotomy for microneurosurgical ablation in 11 patients (20%) or endovascular embolization in 36 patients (65%). Follow-up angiography was performed on 46 patients (83%) with documented obliteration in 30 patients (65%). Patients lost to follow-up were classified as treatment failures, adjusting the range of efficacy from 65% to 54%. Three patients (5%) suffered a posttreatment hemorrhage during the follow-up period, but no new permanent neurological deficits resulted from these events. CONCLUSION: Gamma Knife radiosurgery is an effective adjunct therapy for dAVFs with persistence of flow after open neurosurgical resection or endovascular treatment while still maintaining a role in nonaggressive dAVFs not amenable to either surgery or embolization.
BACKGROUND: The current management of intracranial dural arteriovenous fistulas (dAVFs) incorporates a multimodal approach involving microneurosurgery, endovascular embolization, and radiosurgery. OBJECTIVE: To explore the role of Gamma Knife radiosurgery for dAVFs. METHODS: The series includes patients with dAVFs who had Gamma Knife radiosurgery at the University of Virginia Medical Center between 1989 and 2005 with clinical follow-up through 2008. Medical records were reviewed to obtain clinical history, demographic data, and dosimetry. Radiographic records provided the location and anatomy of the dAVFs. Follow-up angiography was performed 2 to 3 years after treatment, with cure defined as complete obliteration of fistulous flow. Follow-up for clinical symptomology and quality of life was obtained from direct patient and primary physician questionnaires. RESULTS: Fifty-five patients underwent Gamma Knife radiosurgery for dAVFs during the study period. Twenty patients (36%) presented with intracranial hemorrhage before radiosurgery. Gamma Knife radiosurgery was preceded by craniotomy for microneurosurgical ablation in 11 patients (20%) or endovascular embolization in 36 patients (65%). Follow-up angiography was performed on 46 patients (83%) with documented obliteration in 30 patients (65%). Patients lost to follow-up were classified as treatment failures, adjusting the range of efficacy from 65% to 54%. Three patients (5%) suffered a posttreatment hemorrhage during the follow-up period, but no new permanent neurological deficits resulted from these events. CONCLUSION: Gamma Knife radiosurgery is an effective adjunct therapy for dAVFs with persistence of flow after open neurosurgical resection or endovascular treatment while still maintaining a role in nonaggressive dAVFs not amenable to either surgery or embolization.
Authors: Adam A Dmytriw; Michael L Schwartz; Michael D Cusimano; Vitor Mendes Pereira; Timo Krings; Michael Tymianski; Ivan Radovanovic; Ronit Agid Journal: Interv Neuroradiol Date: 2016-12-16 Impact factor: 1.610
Authors: Robert M Starke; David J McCarthy; Ching-Jen Chen; Hideyuki Kano; Brendan McShane; John Lee; David Mathieu; Lucas T Vasas; Anthony M Kaufmann; Wei Gang Wang; Inga S Grills; Mohana Rao Patibandla; Christopher P Cifarelli; Gabriella Paisan; John A Vargo; Tomas Chytka; Ladislava Janouskova; Caleb E Feliciano; Rafael Rodriguez-Mercado; Daniel A Tonetti; L Dade Lunsford; Jason P Sheehan Journal: J Neurosurg Date: 2019-01-04 Impact factor: 5.115
Authors: Nasser Mohammed; Yi-Chieh Hung; Zhiyuan Xu; Robert M Starke; Hideyuki Kano; John Lee; David Mathieu; Anthony M Kaufmann; Inga S Grills; Christopher P Cifarelli; John A Vargo; Tomas Chytka; Ladislava Janouskova; Caleb E Feliciano; Rafael Rodriguez Mercado; L Dade Lunsford; Jason P Sheehan Journal: World Neurosurg Date: 2019-02-18 Impact factor: 2.104
Authors: Nasser Mohammed; Yi-Chieh Hung; Ching-Jen Chen; Zhiyuan Xu; David Schlesinger; Hideyuki Kano; Veronica Chiang; Judith Hess; John Lee; David Mathieu; Anthony M Kaufmann; Inga S Grills; Christopher P Cifarelli; John A Vargo; Tomas Chytka; Ladislava Janouskova; Caleb E Feliciano; Rafael Rodriguez Mercado; L Dade Lunsford; Jason P Sheehan Journal: Neurosurgery Date: 2020-08-01 Impact factor: 4.654
Authors: Yi-Chieh Hung; Nasser Mohammed; Kathryn N Kearns; Ching-Jen Chen; Robert M Starke; Hideyuki Kano; John Lee; David Mathieu; Anthony M Kaufmann; Wei Gang Wang; Inga S Grills; Christopher P Cifarelli; John Vargo; Tomas Chytka; Ladislava Janouskova; Caleb E Feliciano; Rafael Rodriguez-Mercado; L Dade Lunsford; Jason P Sheehan Journal: Neurosurgery Date: 2020-05-01 Impact factor: 4.654