Gamma Knife Radiosurgery For Cavernous Sinus Dural Arteriovenous Fistulas

Ho Hyun Jung1, Jong-Hee Chang2, Jin Soo Pyen1, Yong-Gou Park2

1Wonju Christian Hospital 2 Severance Hospital

Keywords: dural arteriovenous fistula, gamma knife, arteriovenous fistula, vascular malformation, outcome

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     Dural sinus arteriovenous fistula (DAVF) is rare lesion, and presents its symptoms related with the site and venous drainage route. Its treatment modality includes observation, intermittent manual compression of the ICA, microsurgery, transarterial or transvenous embolization, and radiosurgery.
     We assess the efficacy of gamma knife radiosurgery for the treatment of cavernous sinus DAVF.
     From May 1992 to March 2009, among the 4105 gamma knife radiosurgery procedures, 870 vascular lesions were treated. Among 20 cases of DAVF, 6 cases were involving cavernous sinus. Only 5 patients (4 women and 1man) were included, because of follow-up loss in one case. All patients, except one, had more than one of ocular symptoms, such as ptosis, chemosis, proptosis, and extraocular movement palsy, and all were confirmed by angiography.
     Patients were treated with gamma knife radiosurgery alone (n=3) or with transarterial embolization (n=2). The median follow-up period after gamma knife radiosurgery was 30 months (range, 9-58 mo).
     All patients experienced improvement of their ocular symptoms clinically. Total obliteration of AVF was confirmed by follow-up angiography in 4 of them.
     This is a retrospective study.
     No patient experienced complications related with procedure and a recurrence of previous ocular symptoms till last follow-up.
      Gamma knife radiosurgery may play a role as an effective alternative treatment modality for the failed or difficult to treat cavernous sinus DAVF by endovascular approach.


Project Roles:

H. Jung (), J. Chang (), J. Pyen (), Y. Park ()