OBJECT: The goal of this study was to assess the efficacy of Gamma Knife surgery (GKS) in the management of dural arteriovenous fistulas (dAVFs). METHODS: The authors performed a retrospective analysis of a group of 22 patients who underwent GKS for dAVFs at the University of Tokyo Hospital between 1991 and 2009. The patients underwent CT or MR imaging with contrast enhancement every 6 months after GKS; when obliteration of a dAVF was indicated by these images, patients also underwent angiography. Follow-up in these patients ranged from 12 months to 100 months (median 33 months) after GKS. RESULTS: Obliteration of the dAVF was confirmed by neuroimaging in 12 patients (55%). According to a Kaplan-Meier analysis, obliteration rates for the dAVFs were 51% at 3 years and 80% at 5 years. The obliteration rate for lesions without cortical venous drainage (CVD) was 86%, which was significantly higher than the rate for dAVFs with CVD (47%) (p = 0.007). Hemorrhage at presentation (p = 0.03), a target volume less than 1.5 cm(3) (p = 0.009), and Cognard Type III or IV dAVF (p = 0.005) were factors associated with a higher obliteration rate. Among 10 patients whose dAVFs were not obliterated by the initial GKS, 5 patients underwent additional treatment and complete obliteration was achieved in all. Relief of tinnitus was obtained in 5 (83%) of 6 patients with transverse-sigmoid sinus dAVFs, and ophthalmic symptoms improved in 2 (67%) of 3 patients with cavernous sinus dAVFs. No patient experienced interval hemorrhage or radiation-induced complications after treatment. CONCLUSIONS: Gamma Knife surgery is a safe and effective treatment for dAVF. It can be a first line of therapy in the multidisciplinary treatment strategy for dAVFs, especially when significant morbidity is anticipated with other therapeutic options. One should be very careful about recommending GKS for patients harboring dAVFs with CVD because of the expected natural history of such a lesion and the possibility of other therapeutic options.
OBJECT: The goal of this study was to assess the efficacy of Gamma Knife surgery (GKS) in the management of dural arteriovenous fistulas (dAVFs). METHODS: The authors performed a retrospective analysis of a group of 22 patients who underwent GKS for dAVFs at the University of Tokyo Hospital between 1991 and 2009. The patients underwent CT or MR imaging with contrast enhancement every 6 months after GKS; when obliteration of a dAVF was indicated by these images, patients also underwent angiography. Follow-up in these patients ranged from 12 months to 100 months (median 33 months) after GKS. RESULTS: Obliteration of the dAVF was confirmed by neuroimaging in 12 patients (55%). According to a Kaplan-Meier analysis, obliteration rates for the dAVFs were 51% at 3 years and 80% at 5 years. The obliteration rate for lesions without cortical venous drainage (CVD) was 86%, which was significantly higher than the rate for dAVFs with CVD (47%) (p = 0.007). Hemorrhage at presentation (p = 0.03), a target volume less than 1.5 cm(3) (p = 0.009), and Cognard Type III or IV dAVF (p = 0.005) were factors associated with a higher obliteration rate. Among 10 patients whose dAVFs were not obliterated by the initial GKS, 5 patients underwent additional treatment and complete obliteration was achieved in all. Relief of tinnitus was obtained in 5 (83%) of 6 patients with transverse-sigmoid sinus dAVFs, and ophthalmic symptoms improved in 2 (67%) of 3 patients with cavernous sinus dAVFs. No patient experienced interval hemorrhage or radiation-induced complications after treatment. CONCLUSIONS: Gamma Knife surgery is a safe and effective treatment for dAVF. It can be a first line of therapy in the multidisciplinary treatment strategy for dAVFs, especially when significant morbidity is anticipated with other therapeutic options. One should be very careful about recommending GKS for patients harboring dAVFs with CVD because of the expected natural history of such a lesion and the possibility of other therapeutic options.
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; 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