Gamma Knife surgery for the management of cavernous sinus dural arteriovenous fistulas

THANH BINH NGUYEN1, Nguyen Dinh Nguyen2, Nguyen Minh Nguyen2, Nguyen Tuong Nguyen2

1 2Neurosurgery Department, Choray Hospital, Ho Chi Minh City, Vietnam.

Keywords: dural arteriovenous fistula, gamma knife, cavernous sinus, radiosurgery, outcome

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     Arteriovenous fistulas of the cavernous sinus pose unique challenges.
     The purpose of this study was to assess the efficacy and safety of Gamma Knife surgery (GKS) for the treatment of cavernous sinus dural arteriovenous fistulas (CSDAVFs).
     Among the 52 GKS procedures performed for DAVFs in the authors’ institute, 31 cases CSDAVFs with clinical follow up formed the database from which the authors determined clinical outcome and the incidence of untoward events. 28 cases CSDAVFs with imaging follow up formed the database from which the authors determined the imaging results.
     We evaluated clinical and imaging outcomes.
     Older age, female sex, higher incidence of diabetes, and shorter duration of symptoms were noted more in cases of CSDAVF than in ODAVFs. Most patients had symptomatic improvement after GKS. A symptomatic cure was observed in one patient with CSDAVFs as early as 6 weeks. The cumulative cure rate based on follow-up angiography of CSDAVFs approached 90% at 6 months, A neuroimaging-based cure lagged behind that of the clinical symptoms. Overall, there were no nonfatal intracerebral hemorrhages during the follow-up period. No neurological status without hemorrhage was noted with CSDAVFs. There were no cranial nerve neuropathies.
     This was a retrospective study.
     Gamma Knife surgery provides a safe and effective option for treatment of intracranial CSDAVFs with a low risk of complications.
     In cases of CSDAVFs with benign clinical presentation, GKS can serve as a primary treatment. In some cases of aggressive CSDAVFs in which there is extensive retrograde cortical vein drainage, combined treatment with embolization or surgery is suggested.


Project Roles:

T. NGUYEN (), N. Nguyen (), N. Nguyen (), N. Nguyen ()