GKS for Dural AVF

Keywords: dural arteriovenous fistula, gamma knife, cavernous sinus, outcome, radiation-associated tumor

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     Sometimes surgery was associated with major morbidity because some locations were not easily accessible. Radiosurgery and endovascular embolization developed.
     We assess the role of Gamma knife radiosurgery for dural arteriovenous fistulas and carotid-cavernous fistula (CCF) in role of primary or secondary treatment after embolization.
     Between 1994 and July 2011 we treated 15 patients with dural arteriovenous fistulas and carotid-cavernous fistula (CCF). 2 patients were follow up lost. All patients were symptomatic.
     Before radiosurgery, embolization was performed in 7 patients. The mean patient age was 50 years(19-83). The mean radiation dose to the margin of the angiographically defined fistulas was 19.3 Gy at the 50 % or higher isodose line.
     We reviewed the results of clinical follow-up evalutions between 6 and 43 months after radiosurgical treatment. Follow up angiography or MR angiography underwent at least after treatment showed that 77.5 % were totally obliterated . Total obliteration percentage of preGKS embolization group to no embolization group was 87.5: 67. One 57-year-male dural AVF patient developed postradiosurgery complication (radiation associated glioblastoma) after 4 years later.
     This was a retrospective study.
     Radiosurgery and/ or embolization can provide a useful treatment for Dural arteriovenous fistulas and caroticocavernous fistula(CCF). Radiourgery followed by embolization in selected patients is a safe and effective treatment in selected patients with symptomatic or high risk Dural arteriovenous fistulas.
     But, radiation-associated astrocytoma can develop after GK radiosurgery very rarely. We should be suspicious the tumor if the patient''s condition is worse after Gamma-Knife radiosurgery in dural AVF.


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