Gamma Knife Radiosurgery For Dural Arteriovenous FistulasKeywords: arteriovenous fistula, radiosurgery, gamma knife, embolization, outcomeInteractive Manuscript
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What is the background behind your study?
The current management of intracranial dural arteriovenous fistulas (dAVFs) incorporates a multimodal approach involving microneurosurgery, endovascular embolization, as well as radiosurgery.
What is the purpose of your study?
This study explores the role of a Gamma Knife radiosurgery (GKRS) for dAVFs.
Describe your patient group.
The series includes 55 patients with a diagnosed dAVF having undergone Gamma Knife radiosurgery at the University of Virginia Medical Center between 1989 and 2005 with clinical follow-up through 2008.
Describe what you did.
A review of medical records was used to obtain clinical history,
demographic data, as well as dosimetry. Radiographic records provided
location and anatomy of the fistulous malformations. Follow-up
angiography was performed at a two to three year interval after
treatment with cure defined as complete obliteration of flow through the
lesion. Additional follow-up related to clinical symptomatology and
quality of life was obtained from direct patient and primary care
physician questionnaires received up to nineteen years after initial
treatment.
Describe your main findings.
Fifty-five patients underwent GKRS for dAVF during the study period. Complete medical records were available for all patients, with twenty patients (36%) presenting with intracranial hemorrhage before GKRS. Gamma Knife radiosurgery was preceded by craniotomy for microneurosurgical ablation in eleven patients (20%) or endovascular embolization in thirty-six patients (65%). Follow-up angiography was performed on forty-six patients (83%) with a documented obliteration achieved in thirty of these patients (65%). Patients lost to follow-up were classified as failures of treatment, thus adjusting the range of efficacy from 65% to 54%. Three patients (5%) suffered from a post-treatment hemorrhage during the follow-up period, but no new permanent neurological deficits resulted from these events.
Describe the main limitation of this study.
This was a retrospective study.
Describe your main conclusion.
Gamma Knife radiosurgery is an effective adjunct therapy for dAVFs with persistence of flow following open neurosurgical resection or endovascular treatment while still maintaining a role in non-aggressive dAVFs not amenable to either surgery or embolization.
Describe the importance of your findings and how they can be used by others.
Methods to improve obliteration rates further will be of value.
The current management of intracranial dural arteriovenous fistulas (dAVFs) incorporates a multimodal approach involving microneurosurgery, endovascular embolization, as well as radiosurgery.
This study explores the role of a Gamma Knife radiosurgery (GKRS) for dAVFs.
The series includes 55 patients with a diagnosed dAVF having undergone Gamma Knife radiosurgery at the University of Virginia Medical Center between 1989 and 2005 with clinical follow-up through 2008.
A review of medical records was used to obtain clinical history,
demographic data, as well as dosimetry. Radiographic records provided
location and anatomy of the fistulous malformations. Follow-up
angiography was performed at a two to three year interval after
treatment with cure defined as complete obliteration of flow through the
lesion. Additional follow-up related to clinical symptomatology and
quality of life was obtained from direct patient and primary care
physician questionnaires received up to nineteen years after initial
treatment.
Fifty-five patients underwent GKRS for dAVF during the study period. Complete medical records were available for all patients, with twenty patients (36%) presenting with intracranial hemorrhage before GKRS. Gamma Knife radiosurgery was preceded by craniotomy for microneurosurgical ablation in eleven patients (20%) or endovascular embolization in thirty-six patients (65%). Follow-up angiography was performed on forty-six patients (83%) with a documented obliteration achieved in thirty of these patients (65%). Patients lost to follow-up were classified as failures of treatment, thus adjusting the range of efficacy from 65% to 54%. Three patients (5%) suffered from a post-treatment hemorrhage during the follow-up period, but no new permanent neurological deficits resulted from these events.
This was a retrospective study.
Gamma Knife radiosurgery is an effective adjunct therapy for dAVFs with persistence of flow following open neurosurgical resection or endovascular treatment while still maintaining a role in non-aggressive dAVFs not amenable to either surgery or embolization.
Methods to improve obliteration rates further will be of value.
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