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Stereotactic Radiosurgery for Dural Arteriovenous Fistulas Involving the Transverse-Sigmoid Sinus : A Single Center Experience and Review of the Literatures

Journal of Korean Neurosurgical Society 2019년 62권 4호 p.458 ~ 466
 ( Baek Hong-Gyu ) - Kyungpook National University School of Medicine Department of Neurosurgery

 ( Park Seong-Hyun ) - Kyungpook National University School of Medicine Department of Neurosurgery
 ( Park Ki-Su ) - Kyungpook National University School of Medicine Department of Neurosurgery
 ( Kang Dong-Hun ) - Kyungpook National University School of Medicine Department of Neurosurgery
 ( Hwang Jeong-Hyun ) - Kyungpook National University School of Medicine Department of Neurosurgery
 ( Hwang Sung-Kyoo ) - Kyungpook National University School of Medicine Department of Neurosurgery

Abstract


Objective: We retrospectively assessed the efficacy of stereotactic radiosurgery (SRS) for dural arteriovenous fistulas (DAVFs) involving the transverse-sigmoid sinus and analyzed the angiographic and clinical results with our 8-year experience.

Methods: Nine patients with intracranial DAVFs involving the transverse-sigmoid sinus underwent SRS using a Gamma Knife® (Elekta Inc., Atlanta, GA, USA) between 2009 and 2016. Five patients underwent SRS for residual DAVFs after embolization and four patients were treated with SRS alone. The median target volume was 1.9 cm3 (range, 0.8-14.2) and the median radiation dose of the target was 17 Gy (range, 16-20). The median follow-up period was 37 months (range, 7-81).

Results: Pulsating tinnitus (33%) was the most common symptom. DAVFs were completely obliterated in four patients (44%) and subtotally obliterated in five (56%). Six patients (67%) showed complete recovery of symptoms or signs, and three (33%) showed incomplete recovery. One patient experienced a recurrent seizure. Adverse radiation effects after SRS occurred in one patient (11%). The total obliteration rates after SRS were 16.7%, 37.5%, and 68.7% at 1, 2, and 3 years, respectively. The median interval from SRS to total obliteration of the fistula was 31 months (range, 12-38). The rates at which the symptoms started to improve were 40% at 1 month and 80% at 2 months after SRS. Symptoms started to improve at a median of 5 weeks after SRS (range, 3-21).

Conclusion: SRS with or without embolization is a safe and effective treatment to relieve symptoms and obliterate DAVFs on the transverse-sigmoid sinus.

키워드

Central nervous system vascular malformations; Radiosurgery; Transverse sinuses
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