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Wang P, Zhang L, Zhang W, Shi T, Sun Y, Cui S, Zhang D, Kong F, Wang T. Dural arteriovenous fistula with spinal dural arteriovenous fistula: a case report and review of the literature. J Med Case Rep 2023; 17:467. [PMID: 37872601 PMCID: PMC10594680 DOI: 10.1186/s13256-023-04170-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 09/09/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND This paper analyzed the cases of dural arteriovenous fistula (DAVF) with spinal dural arteriovenous fistula (SDAVF) in the diagnosis and treatment process. CASE PRESENTATION One case involving dural arteriovenous fistula (DAVF) with spinal dural arteriovenous fistula (SDAVF) from the 306th Hospital of PLA was retrospectively analyzed. The patient consulted the doctor due to lower limb sensory and motor disorders while exhibiting symptoms of urinary dysfunction. A computed tomographic angiography (CTA) and cerebral angiography confirmed the diagnosis of dural arteriovenous fistula (DAVF), necessitating surgical treatment. The patient was referred to our hospital for an magnetic resonance imaging (MRI) and a spinal angiography to obtain a confirmed diagnosis for spinal arteriovenous fistula, after which they underwent surgical fistula resection. The invasive intracranial dural arteriovenous fistula (DAVF) resection proceeded smoothly but did not ease the patient's symptoms. However, postoperative symptoms were partially relieved by the lumbar open spinal dural arteriovenous fistula adminstration. CONCLUSIONS Since not enough is understood about these two diseases, the rate of misdiagnosis is significantly increased. Early diagnosis and treatment of spinal dural arteriovenous fistula (SDAVF) can play a positive role during the recovery from neural function damage.
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Affiliation(s)
- Peixin Wang
- Department of Neurosurgery, PLA Strategic Support Force Characteristic Medical Center, Beijing, 100101, China
| | - Lele Zhang
- Department of Spine Surgery, PLA Strategic Support Force Characteristic Medical Center, Beijing, 100101, China
| | - Wenqian Zhang
- Department of Neurosurgery, PLA Strategic Support Force Characteristic Medical Center, Beijing, 100101, China
- 306th Clinical College of PLA, The Fifth Clinical Medical College, Anhui Medical University, Beijing, 100101, China
| | - Tiejun Shi
- Department of Neurosurgery, PLA Strategic Support Force Characteristic Medical Center, Beijing, 100101, China
| | - Yikun Sun
- Department of Neurosurgery, PLA Strategic Support Force Characteristic Medical Center, Beijing, 100101, China
| | - Shaojie Cui
- Department of Neurosurgery, PLA Strategic Support Force Characteristic Medical Center, Beijing, 100101, China
| | - Dan Zhang
- Core Facility, Center of Biomedical Analysis, Tsinghua University, Beijing, 100091, China
| | - Fanxuan Kong
- Department of Neurosurgery, PLA Strategic Support Force Characteristic Medical Center, Beijing, 100101, China.
| | - Tao Wang
- Department of Neurosurgery, PLA Strategic Support Force Characteristic Medical Center, Beijing, 100101, China.
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Shinya Y, Hasegawa H, Kawashima M, Koizumi S, Katano A, Umekawa M, Saito N. Prognosis of Rotational Angiography-Based Stereotactic Radiosurgery for Dural Arteriovenous Fistulas: A Retrospective Analysis. Neurosurgery 2023; 92:167-178. [PMID: 36255184 DOI: 10.1227/neu.0000000000002168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 07/26/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Cerebral dural arteriovenous fistulas (DAVFs) are intracranial vascular malformations with fine, abnormal vascular architecture. High-resolution vascular imaging is vital for their visualization. Currently, rotational angiography (RA) provides the finest 3-dimensional visualization of the arteriovenous shunt with high spatial resolution; however, the efficacies of the integration of RA have never been studied in stereotactic radiosurgery (SRS) for DAVFs until now. Since 2015, our institution has integrated RA into SRS (RA-SRS) to provide more conformal planning, thereby decreasing overtreatment and undertreatment. OBJECTIVE To analyze the outcomes of RA-SRS for DAVFs. METHODS We retrospectively analyzed the outcomes of 51 patients with DAVFs and compared those of 20 DAVFs treated with RA-SRS with those of 31 DAVFs treated with conventional SRS (c-SRS). RESULTS The time to obliteration was shorter in the RA-SRS group (median, 15 months vs 26 months [cumulative rate, 77% vs 33% at 2 years, 77% vs 64% at 4 years]; P = .015). Multivariate Cox proportional hazards analysis demonstrated that RA-SRS (hazard ratio 2.39, 95% CI 1.13-5.05; P = .022) and the absence of cortical venous reflux (hazard ratio 2.12, 95% CI 1.06-4.25; P = .034) were significantly associated with obliteration. The cumulative 5-year post-SRS stroke-free survival rates were 95% and 97% in the RA-SRS and c-SRS groups, respectively ( P = .615). Neurological improvement tended to occur earlier in the RA-SRS group than in the c-SRS group (median time to improvement, 5 months vs 20 months, log-rank test; P = .077). CONCLUSION RA-based SRS may facilitate earlier fistula obliteration and may contribute to early neurological improvement.
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Affiliation(s)
- Yuki Shinya
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Hirotaka Hasegawa
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Mariko Kawashima
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Satoshi Koizumi
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Atsuto Katano
- Department of Radiology, The University of Tokyo Hospital, Tokyo, Japan
| | - Motoyuki Umekawa
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Nobuhito Saito
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan
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Voldřich R, Charvát F, Beneš V, Netuka D. What is the most effective method to treat indirect carotid-cavernous fistula? Neurosurg Rev 2022; 46:9. [PMID: 36482213 DOI: 10.1007/s10143-022-01923-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 11/11/2022] [Accepted: 11/28/2022] [Indexed: 12/13/2022]
Abstract
To review the most relevant treatment options for indirect carotid-cavernous fistulas (iCCF), cohorts of 20 patients or more published after 2000 were analyzed. Clinical and radiological outcomes, as well as embolization techniques and material, had to be clarified in the study to be considered. Statistical analysis was based on calculating the relative percentage of therapeutic methods or embolic material, followed by calculating parametric and nonparametric correlations. Some 22 studies and 1550 patients were included. Transvenous embolization (TVE) was used in 53% of the patients and was strongly associated with coiling (rw = 0.66, p = 0.0.0012; rs = 0.53, p = 0.0138), transarterial embolization (TAE) was preferred in 11% of the patients and was strongly linked to liquid embolics (rw = 0.44, p = 0.0434;rs = 0.64, p = 0.0018). A combination of TAE and TVE treatment was used in 7% and a combination of embolic materials in 13% of the patients. None of the endovascular techniques or embolization materials showed significant superiority over the others in clinical outcome and obliteration rate. Radiosurgery in 22% and mechanical compression in 5% of patients showed a lower obliteration rate (rw = - 0.48, p = 0.0254; rs = - 0.45, p = 0.0371). The clinical outcomes were comparable to endovascular treatment (EVT). The remaining 2% of the patients were treated by open surgery or a combination of EVT and radiosurgery. Transvenous coiling is the preferred EVT method for iCCF. However, comparable results may be accomplished with TAE using liquid. Radiosurgery may achieve a lower percentage of fistula occlusion, but the clinical results are equal to EVT.
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Affiliation(s)
- Richard Voldřich
- Department of Neurosurgery and Neurooncology, Military University Hospital and First Medical Faculty of Charles University, Prague, Czech Republic.
| | - František Charvát
- Department of Radiology, Military University Hospital, Prague, Czech Republic
| | - Vladimír Beneš
- Department of Neurosurgery and Neurooncology, Military University Hospital and First Medical Faculty of Charles University, Prague, Czech Republic
| | - David Netuka
- Department of Neurosurgery and Neurooncology, Military University Hospital and First Medical Faculty of Charles University, Prague, Czech Republic
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Kim MJ, Hong SW, Kim DJ, Kim BM, Kim YB, Chang WS, Park KY. Efficacy and safety of stereotactic radiosurgery versus endovascular treatment for symptomatic cavernous sinus dural arteriovenous fistula without ophthalmological emergency: a single-center 10-year experience. J Neurosurg 2022:1-11. [DOI: 10.3171/2022.10.jns221770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 10/18/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE
Stereotactic radiosurgery (SRS) is emerging as a treatment option for cavernous sinus dural arteriovenous fistula (CS dAVF); it is less invasive and has a lower complication rate than conventional surgeries. However, little is known regarding the advantages and limitations of SRS compared to those of endovascular treatment (EVT). The aim of this study was to compare the efficacy and safety between EVT and SRS for treatment of CS dAVF.
METHODS
Between January 2011 and April 2021, a total of 86 consecutive patients diagnosed with CS dAVF were treated with EVT or SRS. Among them, 8 patients with ophthalmological emergency and 8 without follow-up data at ≥ 12 months were excluded. During the same period, no neurological deficit due to intracranial hemorrhage or seizure was noted in any of the patients. Ultimately, 70 patients (EVT 33, SRS 37) were included in this study. Demographic characteristics, initial clinical presentations, clinical outcomes, and radiological findings were retrospectively reviewed and compared. Procedure-related complications were also assessed after the treatments.
RESULTS
The patients’ baseline characteristics (except conjunctival symptoms) and angiographic features of CS dAVF were not significantly different between the EVT and SRS groups. Conjunctival symptoms were more frequently noted in the EVT than in the SRS group (69.7% vs 40.5%, p = 0.015). After EVT, initial complete obliteration was achieved in 20 cases (60.6%). Complete obliteration was achieved at 6 months in 86.4% of cases with EVT and in 77.8% of those treated with SRS (p = 0.507), and at 12 months in 86.4% cases with EVT and in 94.4% of those treated with SRS (p = 0.357). Worsening of symptoms developed at 1 month in 24.2% of cases with EVT and in 5.4% of those treated with SRS (p = 0.038); at 6 months in 22.6% of cases with EVT and in 10.8% of those treated with SRS; and at 12 months in 30.0% of cases with EVT and in 13.5% of those treated with SRS (p = 0.099). The angioarchitecture of CS dAVF did not affect angiographic obliteration after SRS. Procedure-related morbidity and mortality occurred more frequently in the EVT than in the SRS group (27.3% vs 8.1%, p = 0.034).
CONCLUSIONS
Both EVT and SRS were effective for the treatment of CS dAVF without ophthalmological emergency. However, procedure-related morbidity and mortality was less frequent in SRS than in EVT, and consequently SRS may be more advantageous in terms of safety.
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Affiliation(s)
- Min Jeoung Kim
- Department of Radiology, Severance Stroke Center, Severance Hospital, Yonsei University College of Medicine, Seoul
| | - Seung Woo Hong
- Department of Neurosurgery, Yonsei Gamma Knife Center, Severance Hospital, Yonsei University College of Medicine, Seoul; and
| | - Dong Joon Kim
- Department of Radiology, Severance Stroke Center, Severance Hospital, Yonsei University College of Medicine, Seoul
| | - Byung Moon Kim
- Department of Radiology, Severance Stroke Center, Severance Hospital, Yonsei University College of Medicine, Seoul
| | - Yong Bae Kim
- Department of Neurosurgery, Severance Stroke Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Won Seok Chang
- Department of Neurosurgery, Yonsei Gamma Knife Center, Severance Hospital, Yonsei University College of Medicine, Seoul; and
| | - Keun Young Park
- Department of Neurosurgery, Severance Stroke Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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Alkhaibary A, Alnefaie N, Alharbi A, Alammar H, Arishy AM, Alshaya W, Khairy S. Intracranial dural arteriovenous fistula: a comprehensive review of the history, management, and future prospective. Acta Neurol Belg 2022; 123:359-366. [PMID: 36374476 DOI: 10.1007/s13760-022-02133-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 10/23/2022] [Indexed: 11/16/2022]
Abstract
Dural arteriovenous fistulas (DAVF) are abnormal acquired intracranial vascular malformations consisting of pathological connections located within the dura between the pial arteries and the veno vasora, comprising the walls of the dural sinuses, bridging veins, or transosseous emissary veins. Dural arteriovenous fistulas are distinguished from arteriovenous malformations by their arterial supply from the vessels that perfuse the dura mater and lack of a parenchymal nidus. They are most commonly situated at the transverse and cavernous sinuses. The mechanism of development behind dural arteriovenous fistula can be explained by the molecular and anatomical factors. Multiple classification systems have been proposed throughout history including; Djindjian and Merland, Cognard, and Borden classification systems. The aggressiveness of the clinical course in intracranial dural arteriovenous fistula can be predicted through the angiographic patterns of venous drainage, more specifically, the presence of cortical venous drainage, the presence of venous ectasia, and the aggressiveness of clinical presentation. Intracranial dural arteriovenous fistulas might be discovered incidentally. However, if symptomatic, the clinical presentation ranges from mild neurological deficits to severe, lethal intracranial hemorrhage. Angiography is the imaging of choice to investigate, diagnose, and plan treatment for intracranial dural arteriovenous fistula. The management algorithm of intracranial dural arteriovenous fistula can be broadly divided into conservative, surgical, endovascular, and/or radiosurgical options. With the advent of endovascular therapies, surgery has fallen out of favor for managing intracranial dural arteriovenous fistulas. In the present article, the pathophysiology, classifications, natural history, clinical manifestations, radiological features, management, and complications are comprehensively reviewed.
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Sinovenous outflow in lateral sinus dural arteriovenous fistulas after stereotactic radiosurgery: a retrospective longitudinal imaging study. Acta Neurochir (Wien) 2022; 164:2409-2418. [PMID: 35831724 DOI: 10.1007/s00701-022-05310-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 07/03/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE To investigate sinovenous outflow restriction (SOR) in lateral sinus dural arteriovenous fistulas (LSDAVFs) after Gamma Knife radiosurgery (GKRS) and its association with complete obliteration. METHODS We retrospectively (1995-2019) enrolled 39 patients with LSDAVFs who had undergone GKRS alone and evaluated their angiography and magnetic resonance imaging (MRI) before and after GKRS. The LS conduits ipsilateral and contralateral to the DAVFs were scored using a 5-point scoring system, with scores ranging from 0 (total occlusion) to 4 (fully patent). SOR was defined by a conduit score < 2. Demographics, imaging features, and outcomes were compared between patients with and without ipsilateral SOR after GKRS. Logistic regression analysis was performed to estimate the odds ratio (OR) for obliteration with the imaging findings. RESULTS After a median angiographic follow-up of 28 months for the 39 patients, the ipsilateral LS became more restrictive (median conduit score before and after GKRS: 2 vs. 1, p = .011). Twenty-one patients with ipsilateral SOR after GKRS had a significantly lower obliteration rate (52.4% vs. 94.4%, p = .005) than those without SOR. Follow-up SOR was independently associated with a lower obliteration rate (OR 0.05, p = .017) after adjustment for age, cortical venous reflux, and absent sinus flow void on MRI. CONCLUSION This study demonstrates a restrictive change of outflow in LSDAVFs after GKRS and a lower obliteration rate in patients with SOR. Follow-up imaging for SOR may help predict outcomes of these patients.
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Kim JY, Kim SY, Lee D. A Case with Bilateral Dural Arteriovenous Fistulae Manifesting as Sequential Trochlear, Oculomotor Nerve Palsies. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2022. [DOI: 10.3341/jkos.2022.63.7.642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Purpose: We report a patient with bilateral dural arteriovenous fistulae (DAVF) who initially presented with unilateral, isolated trochlear nerve palsy; and later with contralateral, oculomotor nerve palsy.Case summary: A 72-year-old male without any underlying disease or a trauma history visited with sudden vertical diplopia in both eyes that had developed 5 days prior. Brain magnetic resonance imaging (MRI) performed before his first visit was unremarkable. The eye movement test revealed hyperdeviation and limitation of downgaze in the left eye; we thus suspected unilateral, ischemic trochlear nerve palsy and this was indeed observed. However, the diplopia did not improve and limitations of the upper, medial gaze of the right eye developed after 3 months. Follow-up examinations (orbital computed tomography, brain MRI, and cerebral angiography) revealed bilateral DAVF running from the left to the right. He underwent gamma-knife radiosurgery; then the eye movement limitations and diplopia improved.Conclusions: Diplopia manifesting as paralysis in an elderly patient may be caused by DAVF; the diplopia may not always be the common ischemic paralytic strabismus. DAVF should be considered during differential diagnosis and further radiological examinations may be needed.
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Chang SJ, Haw CS, Redekop GJ. Commentary: Stereotactic Radiosurgery for Dural Arteriovenous Fistulas: A Systematic Review and Meta-Analysis and International Stereotactic Radiosurgery Society Practice Guidelines. Neurosurgery 2022; 91:e1-e2. [PMID: 35383713 DOI: 10.1227/neu.0000000000001972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 02/17/2022] [Indexed: 11/18/2022] Open
Affiliation(s)
- Stephano J Chang
- Division of Neurosurgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
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Singh R, Chen CJ, Didwania P, Kotecha R, Fariselli L, Pollock BE, Levivier M, Paddick I, Yomo S, Suh JH, Sahgal A, Sheehan JP. Stereotactic Radiosurgery for Dural Arteriovenous Fistulas: A Systematic Review and Meta-Analysis and International Stereotactic Radiosurgery Society Practice Guidelines. Neurosurgery 2022; 91:43-58. [PMID: 35383682 DOI: 10.1227/neu.0000000000001953] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 01/16/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Dural arteriovenous fistulas (dAVFs) are often treated with stereotactic radiosurgery (SRS) to achieve complete obliteration (CO), prevent future hemorrhages, and ameliorate neurological symptoms. OBJECTIVE To summarize outcomes after SRS for dAVFs and propose relevant practice recommendations. METHODS Using a PICOS/PRISMA/MOOSE protocol, we included patients with dAVFs treated with SRS and data for at least one of the outcomes of the study. Relevant outcomes were CO, symptom improvement and cure, and post-SRS hemorrhage or permanent neurological deficits (PNDs). Estimated outcome effect sizes were determined using weighted random-effects meta-analyses using DerSimonian and Laird methods. To assess potential relationships between patient and lesion characteristics and clinical outcomes, mixed-effects weighted regression models were used. RESULTS Across 21 published studies, we identified 705 patients with 721 dAVFs treated with SRS. The CO rate was 68.6% (95% CI 60.7%-76.5%) with symptom improvement and cure rates of 97.2% (95% CI 93.2%-100%) and 78.8% (95% CI 69.3%-88.2%), respectively. Estimated incidences of post-SRS hemorrhage and PNDs were 1.1% (95% CI 0.6%-1.6%) and 1.3% (95% CI 0.8%-1.8%), respectively. Noncavernous sinus (NCS) dAVFs were associated with lower CO (P = .03) and symptom cure rates (P = .001). Higher grade was also associated with lower symptom cure rates (P = .04), whereas previous embolization was associated with higher symptom cure rates (P = .01). CONCLUSION SRS for dAVFs results in CO in the majority of patients with excellent symptom improvement rates with minimal toxicity. Patients with NCS and/or higher-grade dAVFs have poorer symptom cure rates. Combined therapy with embolization and SRS is recommended when feasible for clinically aggressive dAVFs or those refractory to embolization to maximize the likelihood of symptom cure.
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Affiliation(s)
- Raj Singh
- Department of Radiation Oncology, Virginia Commonwealth University Health System, Richmond, Virginia, USA
| | - Ching-Jen Chen
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Prabhanjan Didwania
- Rady School of Management, University of California San Diego, San Diego, California, USA
| | - Rupesh Kotecha
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida, USA
| | - Laura Fariselli
- Radiotherapy Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Bruce E Pollock
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Marc Levivier
- Department of Neurosurgery and Gamma Knife Center, Lausanne University Hospital, Lausanne, Switzerland
| | - Ian Paddick
- Queen Square Radiosurgery Centre, National Hospital for Neurology and Neurosurgery, London, UK
| | - Shoji Yomo
- Division of Radiation Oncology, Aizawa Comprehensive Cancer Center, Aizawa Hospital, Matsumoto, Japan
| | - John H Suh
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Arjun Sahgal
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
| | - Jason P Sheehan
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA
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Hasegawa H, Shin M, Kawagishi J, Jokura H, Hasegawa T, Kato T, Kawashima M, Shinya Y, Kenai H, Kawabe T, Sato M, Serizawa T, Nagano O, Aoyagi K, Kondoh T, Yamamoto M, Onoue S, Nakazaki K, Iwai Y, Yamanaka K, Hasegawa S, Kashiwabara K, Saito N. A Practical Grading Scale for Predicting Outcomes of Radiosurgery for Dural Arteriovenous Fistulas: JLGK 1802 Study. J Stroke 2022; 24:278-287. [PMID: 35677982 PMCID: PMC9194540 DOI: 10.5853/jos.2021.03594] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 03/16/2022] [Indexed: 11/11/2022] Open
Abstract
Background and Purpose To assess the long-term outcomes of intracranial dural arteriovenous fistula (DAVF) treated with stereotactic radiosurgery (SRS) alone or embolization and SRS (Emb-SRS) and to develop a grading system for predicting DAVF obliteration.
Methods This multi-institutional retrospective study included 200 patients with DAVF treated with SRS or Emb-SRS. We investigated the long-term obliteration rate and obliteration-associated factors. We developed a new grading system to estimate the obliteration rate. Additionally, we compared the outcomes of SRS and Emb-SRS by using propensity score matching.
Results The 3- and 4-year obliteration rates were 66.3% and 78.8%, respectively. The post-SRS hemorrhage rate was 2%. In the matched cohort, the SRS and Emb-SRS groups did not differ in the rates of obliteration (P=0.54) or post-SRS hemorrhage (P=0.50). In multivariable analysis, DAVF location and cortical venous reflux (CVR) were independently associated with obliteration. The new grading system assigned 2, 1, and 0 points to DAVFs in the anterior skull base or middle fossa, DAVFs with CVR or DAVFs in the superior sagittal sinus or tentorium, and DAVFs without these factors, respectively. Using the total points, patients were stratified into the highest (0 points), intermediate (1 point), or lowest (≥2 points) obliteration rate groups that exhibited 4-year obliteration rates of 94.4%, 71.3%, and 60.4%, respectively (P<0.01).
Conclusions SRS-based therapy achieved DAVF obliteration in more than three-quarters of the patients at 4 years of age. Our grading system can stratify the obliteration rate and may guide physicians in treatment selection.
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Affiliation(s)
- Hirotaka Hasegawa
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Masahiro Shin
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Jun Kawagishi
- Jiro Suzuki Memorial Gamma House, Furukawa Seiryo Hospital, Osaki, Japan
| | - Hidefumi Jokura
- Jiro Suzuki Memorial Gamma House, Furukawa Seiryo Hospital, Osaki, Japan
| | | | - Takenori Kato
- Department of Neurosurgery, Komaki City Hospital, Komaki, Japan
| | - Mariko Kawashima
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Yuki Shinya
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Hiroyuki Kenai
- Department of Neurosurgery, Nagatomi Neurosurgical Hospital, Oita, Japan
| | - Takuya Kawabe
- Kyoto Gamma Knife Center, Rakusai Shimizu Hospital, Kyoto, Japan
| | - Manabu Sato
- Kyoto Gamma Knife Center, Rakusai Shimizu Hospital, Kyoto, Japan
| | - Toru Serizawa
- Tokyo Gamma Unit Center, Tsukiji Neurological Clinic, Tokyo, Japan
| | - Osamu Nagano
- Gamma Knife House, Chiba Cerebral and Cardiovascular Center, Ichihara, Japan
| | - Kyoko Aoyagi
- Gamma Knife House, Chiba Cerebral and Cardiovascular Center, Ichihara, Japan
| | - Takeshi Kondoh
- Department of Neurosurgery, Shinsuma General Hospital, Kobe, Japan
| | | | - Shinji Onoue
- Department of Neurosurgery, Ehime Prefectural Central Hospital, Matsuyama, Japan
| | - Kiyoshi Nakazaki
- Department of Neurosurgery, Brain Attack Center, Ota Memorial Hospital, Fukuyama, Japan
| | - Yoshiyasu Iwai
- Department of Neurosurgery, Osaka City General Hospital, Osaka, Japan
| | - Kazuhiro Yamanaka
- Department of Neurosurgery, Osaka City General Hospital, Osaka, Japan
| | - Seiko Hasegawa
- Department of Neurosurgery, Kuroishi General Hospital, Kuroishi, Japan
| | - Kosuke Kashiwabara
- Data Science Office, Clinical Research Promotion Center, The University of Tokyo Hospital, Tokyo, Japan
| | - Nobuhito Saito
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan
- Correspondence: Masahiro Shin Department of Neurosurgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan Tel: +81-3-5800-8853 Fax: +81-3-5800-8655 E-mail:
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11
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Endovascular versus surgical treatment of cranial dural arteriovenous fistulas: a single-center 8-year experience. Acta Neurochir (Wien) 2022; 164:151-161. [PMID: 34486069 PMCID: PMC8761147 DOI: 10.1007/s00701-021-04950-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 04/05/2021] [Indexed: 10/27/2022]
Abstract
BACKGROUND Cranial dural arteriovenous fistulas (dAVFs) are rare lesions managed mainly with endovascular treatment (EVT) and/or surgery. We hypothesize that there may be subtypes of dAVFs responding better to a specific treatment modality in terms of successful obliteration and cessation of symptoms and/or risks. METHODS All dAVFs treated during 2011-2018 at our hospital were analyzed retrospectively. Presenting symptoms, radiological variables, treatment modality, complications, and residual symptoms were related to dAVF type using the original Djindjian classification. RESULTS We treated 112 dAVFs in 107 patients (71, 66% males). They presented with hemorrhage (n = 23; 21%), non-hemorrhagic symptoms (n = 75; 70%), or were discovered incidentally (n = 9; 8%). There were 25 (22%) type I, 29 (26%) type II, 26 (23%) type III, and 32 (29%) type IV fistulas. EVT was the primary treatment modality in 72/112 (64%) dAVFs whereas 40/112 (36%) underwent primary surgery with angiographic obliteration rates of 60% and 90%, respectively. Using a secondary treatment modality in 23 dAVFs, we obtained a final obliteration rate of 93%, including all type III/IV and 26/27 (96%) type II dAVFs. Except for headache, residual symptoms were rare and minor. Permanent neurological complications consisted of five cranial nerve deficits. CONCLUSIONS We recommend EVT as first treatment modality in types I, II, and in non-hemorrhagic type III/IV dAVFs. We recommend surgery as first treatment choice in acute hemorrhagic dAVFs and as secondary choice in type III/IV dAVFs not successfully occluded by EVT. Combining the two modalities provides obliteration in 9/10 dAVF cases at a low procedural risk.
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12
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Guniganti R, Giordan E, Chen CJ, Abecassis IJ, Levitt MR, Durnford A, Smith J, Samaniego EA, Derdeyn CP, Kwasnicki A, Alaraj A, Potgieser ARE, Sur S, Chen SH, Tada Y, Winkler E, Phelps RRL, Lai PMR, Du R, Abla A, Satomi J, Starke RM, van Dijk JMC, Amin-Hanjani S, Hayakawa M, Gross BA, Fox WC, Bulters D, Kim LJ, Sheehan J, Lanzino G, Piccirillo JF, Kansagra AP, Zipfel GJ. Consortium for Dural Arteriovenous Fistula Outcomes Research (CONDOR): rationale, design, and initial characterization of patient cohort. J Neurosurg 2021; 136:951-961. [PMID: 34507282 DOI: 10.3171/2021.1.jns202790] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 01/20/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Cranial dural arteriovenous fistulas (dAVFs) are rare lesions, hampering efforts to understand them and improve their care. To address this challenge, investigators with an established record of dAVF investigation formed an international, multicenter consortium aimed at better elucidating dAVF pathophysiology, imaging characteristics, natural history, and patient outcomes. This report describes the design of the Consortium for Dural Arteriovenous Fistula Outcomes Research (CONDOR) and includes characterization of the 1077-patient cohort. METHODS Potential collaborators with established interest in the field were identified via systematic review of the literature. To ensure uniformity of data collection, a quality control process was instituted. Data were retrospectively obtained. RESULTS CONDOR comprises 14 centers in the United States, the United Kingdom, the Netherlands, and Japan that have pooled their data from 1077 dAVF patients seen between 1990 and 2017. The cohort includes 359 patients (33%) with Borden type I dAVFs, 175 (16%) with Borden type II fistulas, and 529 (49%) with Borden type III fistulas. Overall, 852 patients (79%) presented with fistula-related symptoms: 427 (40%) presented with nonaggressive symptoms such as tinnitus or orbital phenomena, 258 (24%) presented with intracranial hemorrhage, and 167 (16%) presented with nonhemorrhagic neurological deficits. A smaller proportion (224 patients, 21%), whose dAVFs were discovered incidentally, were asymptomatic. Many patients (85%, 911/1077) underwent treatment via endovascular embolization (55%, 587/1077), surgery (10%, 103/1077), radiosurgery (3%, 36/1077), or multimodal therapy (17%, 184/1077). The overall angiographic cure rate was 83% (758/911 treated), and treatment-related permanent neurological morbidity was 2% (27/1467 total procedures). The median time from diagnosis to follow-up was 380 days (IQR 120-1038.5 days). CONCLUSIONS With more than 1000 patients, the CONDOR registry represents the largest registry of cranial dAVF patient data in the world. These unique, well-annotated data will enable multiple future analyses to be performed to better understand dAVFs and their management.
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Affiliation(s)
| | - Enrico Giordan
- Departments of4Neurological Surgery and.,5Radiology, Mayo Clinic, Rochester, Minnesota
| | - Ching-Jen Chen
- 6Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | | | - Michael R Levitt
- 7Department of Neurological Surgery and.,8Stroke and Applied Neuroscience Center, University of Washington, Seattle, Washington
| | - Andrew Durnford
- 9Department of Neurosurgery, University of Southampton, University Hospital Southampton, United Kingdom
| | - Jessica Smith
- 10Department of Neurological Surgery, University of Florida, Gainesville, Florida
| | - Edgar A Samaniego
- Departments of12Neurology and.,13Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Colin P Derdeyn
- Departments of12Neurology and.,13Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Amanda Kwasnicki
- 14Department of Neurological Surgery, University of Illinois at Chicago, Illinois
| | - Ali Alaraj
- 14Department of Neurological Surgery, University of Illinois at Chicago, Illinois
| | - Adriaan R E Potgieser
- 15Department of Neurological Surgery, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Samir Sur
- 16Department of Neurological Surgery and Radiology, University of Miami, Florida
| | - Stephanie H Chen
- 16Department of Neurological Surgery and Radiology, University of Miami, Florida
| | - Yoshiteru Tada
- 17Department of Neurosurgery, Institute of Biomedical Biosciences, Tokushima University Graduate School, Tokushima, Japan
| | - Ethan Winkler
- 18Weill Institute for Neurosciences, Department of Neurosurgery, University of California, San Francisco, California
| | - Ryan R L Phelps
- 18Weill Institute for Neurosciences, Department of Neurosurgery, University of California, San Francisco, California
| | - Pui Man Rosalind Lai
- 19Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Rose Du
- 19Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Adib Abla
- 18Weill Institute for Neurosciences, Department of Neurosurgery, University of California, San Francisco, California
| | - Junichiro Satomi
- 17Department of Neurosurgery, Institute of Biomedical Biosciences, Tokushima University Graduate School, Tokushima, Japan
| | - Robert M Starke
- 16Department of Neurological Surgery and Radiology, University of Miami, Florida
| | - J Marc C van Dijk
- 15Department of Neurological Surgery, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Sepideh Amin-Hanjani
- 14Department of Neurological Surgery, University of Illinois at Chicago, Illinois
| | - Minako Hayakawa
- Departments of12Neurology and.,13Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Bradley A Gross
- 11Department of Neurological Surgery, University of Pittsburgh, Pennsylvania
| | - W Christopher Fox
- 10Department of Neurological Surgery, University of Florida, Gainesville, Florida
| | - Diederik Bulters
- 9Department of Neurosurgery, University of Southampton, University Hospital Southampton, United Kingdom
| | - Louis J Kim
- 7Department of Neurological Surgery and.,8Stroke and Applied Neuroscience Center, University of Washington, Seattle, Washington
| | - Jason Sheehan
- 6Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Giuseppe Lanzino
- Departments of4Neurological Surgery and.,5Radiology, Mayo Clinic, Rochester, Minnesota
| | - Jay F Piccirillo
- 3Department of Otolaryngology, Washington University School of Medicine, St. Louis, Missouri
| | - Akash P Kansagra
- 1Department of Neurological Surgery.,2Mallinckrodt Institute of Radiology, and
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13
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Chen CJ, Buell TJ, Ding D, Guniganti R, Kansagra AP, Lanzino G, Giordan E, Kim LJ, Levitt MR, Abecassis IJ, Bulters D, Durnford A, Fox WC, Polifka AJ, Gross BA, Hayakawa M, Derdeyn CP, Samaniego EA, Amin-Hanjani S, Alaraj A, Kwasnicki A, van Dijk JMC, Potgieser ARE, Starke RM, Sur S, Satomi J, Tada Y, Abla AA, Winkler EA, Du R, Lai PMR, Zipfel GJ, Sheehan JP. Intervention for unruptured high-grade intracranial dural arteriovenous fistulas: a multicenter study. J Neurosurg 2021; 136:962-970. [PMID: 34608140 DOI: 10.3171/2021.1.jns202799] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 01/20/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The risk-to-benefit profile of treating an unruptured high-grade dural arteriovenous fistula (dAVF) is not clearly defined. The aim of this multicenter retrospective cohort study was to compare the outcomes of different interventions with observation for unruptured high-grade dAVFs. METHODS The authors retrospectively reviewed dAVF patients from 12 institutions participating in the Consortium for Dural Arteriovenous Fistula Outcomes Research (CONDOR). Patients with unruptured high-grade (Borden type II or III) dAVFs were included and categorized into four groups (observation, embolization, surgery, and stereotactic radiosurgery [SRS]) based on the initial management. The primary outcome was defined as the modified Rankin Scale (mRS) score at final follow-up. Secondary outcomes were good outcome (mRS scores 0-2) at final follow-up, symptomatic improvement, all-cause mortality, and dAVF obliteration. The outcomes of each intervention group were compared against those of the observation group as a reference, with adjustment for differences in baseline characteristics. RESULTS The study included 415 dAVF patients, accounting for 29, 324, 43, and 19 in the observation, embolization, surgery, and SRS groups, respectively. The mean radiological and clinical follow-up durations were 21 and 25 months, respectively. Functional outcomes were similar for embolization, surgery, and SRS compared with observation. With observation as a reference, obliteration rates were higher after embolization (adjusted OR [aOR] 7.147, p = 0.010) and surgery (aOR 33.803, p < 0.001) and all-cause mortality was lower after embolization (imputed, aOR 0.171, p = 0.040). Hemorrhage rates per 1000 patient-years were 101 for observation versus 9, 22, and 0 for embolization (p = 0.022), surgery (p = 0.245), and SRS (p = 0.077), respectively. Nonhemorrhagic neurological deficit rates were similar between each intervention group versus observation. CONCLUSIONS Embolization and surgery for unruptured high-grade dAVFs afforded a greater likelihood of obliteration than did observation. Embolization also reduced the risk of death and dAVF-associated hemorrhage compared with conservative management over a modest follow-up period. These findings support embolization as the first-line treatment of choice for appropriately selected unruptured Borden type II and III dAVFs.
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Affiliation(s)
- Ching-Jen Chen
- 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Thomas J Buell
- 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Dale Ding
- 18Department of Neurosurgery, University of Louisville, Kentucky
| | - Ridhima Guniganti
- 2Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Akash P Kansagra
- 2Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri.,15Mallinckrodt Institute of Radiology and.,16Department of Neurology, Washington University School of Medicine, St. Louis, Missouri
| | | | - Enrico Giordan
- 3Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota
| | - Louis J Kim
- 4Department of Neurosurgery, University of Washington, Seattle, Washington
| | - Michael R Levitt
- 4Department of Neurosurgery, University of Washington, Seattle, Washington
| | | | - Diederik Bulters
- 5Department of Neurosurgery, University of Southampton, United Kingdom
| | - Andrew Durnford
- 5Department of Neurosurgery, University of Southampton, United Kingdom
| | - W Christopher Fox
- 6Department of Neurosurgery, University of Florida, Gainesville, Florida
| | - Adam J Polifka
- 6Department of Neurosurgery, University of Florida, Gainesville, Florida
| | - Bradley A Gross
- 7Department of Neurological Surgery, University of Pittsburgh, Pennsylvania
| | - Minako Hayakawa
- 8Department of Radiology, University of Iowa, Iowa City, Iowa
| | - Colin P Derdeyn
- 8Department of Radiology, University of Iowa, Iowa City, Iowa
| | | | | | - Ali Alaraj
- 9Department of Neurosurgery, University of Illinois at Chicago, Illinois
| | - Amanda Kwasnicki
- 9Department of Neurosurgery, University of Illinois at Chicago, Illinois
| | - J Marc C van Dijk
- 10Department of Neurosurgery, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Adriaan R E Potgieser
- 10Department of Neurosurgery, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Robert M Starke
- 11Department of Neurosurgery, University of Miami, Florida.,17Department of Radiology, University of Miami, Florida; and
| | - Samir Sur
- 11Department of Neurosurgery, University of Miami, Florida
| | - Junichiro Satomi
- 12Department of Neurosurgery, Tokushima University, Tokushima, Japan
| | - Yoshiteru Tada
- 12Department of Neurosurgery, Tokushima University, Tokushima, Japan
| | - Adib A Abla
- 13Department of Neurosurgery, University of California, San Francisco, California
| | - Ethan A Winkler
- 13Department of Neurosurgery, University of California, San Francisco, California
| | - Rose Du
- 14Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Pui Man Rosalind Lai
- 14Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Gregory J Zipfel
- 2Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Jason P Sheehan
- 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
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14
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Chen CJ, Buell TJ, Ding D, Guniganti R, Kansagra AP, Lanzino G, Brinjikji W, Kim L, Levitt MR, Abecassis IJ, Bulters D, Durnford A, Fox WC, Polifka AJ, Gross BA, Hayakawa M, Derdeyn CP, Samaniego EA, Amin-Hanjani S, Alaraj A, Kwasnicki A, van Dijk JMC, Potgieser ARE, Starke RM, Chen S, Satomi J, Tada Y, Abla A, Phelps RRL, Du R, Lai R, Zipfel GJ, Sheehan JP. Observation Versus Intervention for Low-Grade Intracranial Dural Arteriovenous Fistulas. Neurosurgery 2021; 88:1111-1120. [PMID: 33582776 DOI: 10.1093/neuros/nyab024] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 12/14/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Low-grade intracranial dural arteriovenous fistulas (dAVF) have a benign natural history in the majority of cases. The benefit from treatment of these lesions is controversial. OBJECTIVE To compare the outcomes of observation versus intervention for low-grade dAVFs. METHODS We retrospectively reviewed dAVF patients from institutions participating in the CONsortium for Dural arteriovenous fistula Outcomes Research (CONDOR). Patients with low-grade (Borden type I) dAVFs were included and categorized into intervention or observation cohorts. The intervention and observation cohorts were matched in a 1:1 ratio using propensity scores. Primary outcome was modified Rankin Scale (mRS) at final follow-up. Secondary outcomes were excellent (mRS 0-1) and good (mRS 0-2) outcomes, symptomatic improvement, mortality, and obliteration at final follow-up. RESULTS The intervention and observation cohorts comprised 230 and 125 patients, respectively. We found no differences in primary or secondary outcomes between the 2 unmatched cohorts at last follow-up (mean duration 36 mo), except obliteration rate was higher in the intervention cohort (78.5% vs 24.1%, P < .001). The matched intervention and observation cohorts each comprised 78 patients. We also found no differences in primary or secondary outcomes between the matched cohorts except obliteration was also more likely in the matched intervention cohort (P < .001). Procedural complication rates in the unmatched and matched intervention cohorts were 15.4% and 19.2%, respectively. CONCLUSION Intervention for low-grade intracranial dAVFs achieves superior obliteration rates compared to conservative management, but it fails to improve neurological or functional outcomes. Our findings do not support the routine treatment of low-grade dAVFs.
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Affiliation(s)
- Ching-Jen Chen
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Thomas J Buell
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Dale Ding
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, USA
| | - Ridhima Guniganti
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Akash P Kansagra
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri, USA.,Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA.,Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Giuseppe Lanzino
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Waleed Brinjikji
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Louis Kim
- Department of Neurosurgery, University of Washington, Seattle, Washington, USA
| | - Michael R Levitt
- Department of Neurosurgery, University of Washington, Seattle, Washington, USA
| | | | - Diederik Bulters
- Department of Neurosurgery, University of Southampton, Southampton, United Kingdom
| | - Andrew Durnford
- Department of Neurosurgery, University of Southampton, Southampton, United Kingdom
| | - W Christopher Fox
- Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
| | - Adam J Polifka
- Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
| | - Bradley A Gross
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Minako Hayakawa
- Department of Radiology, University of Iowa, Iowa City, Iowa, USA
| | - Colin P Derdeyn
- Department of Radiology, University of Iowa, Iowa City, Iowa, USA
| | | | | | - Ali Alaraj
- Department of Neurosurgery, University of Illinois, Chicago, Illinois, USA
| | - Amanda Kwasnicki
- Department of Neurosurgery, University of Illinois, Chicago, Illinois, USA
| | - J Marc C van Dijk
- Department of Neurosurgery, University of Groningen, Groningen, the Netherlands
| | | | - Robert M Starke
- Department of Neurosurgery, University of Miami, Miami, Florida, USA.,Department of Radiology, University of Miami, Miami, Florida, USA
| | - Stephanie Chen
- Department of Neurosurgery, University of Miami, Miami, Florida, USA
| | - Junichiro Satomi
- Department of Neurosurgery, Tokushima University, Tokushima, Japan
| | - Yoshiteru Tada
- Department of Neurosurgery, Tokushima University, Tokushima, Japan
| | - Adib Abla
- Department of Neurosurgery, University of California, San Francisco, San Francisco, California, USA
| | - Ryan R L Phelps
- Department of Neurosurgery, University of California, San Francisco, San Francisco, California, USA
| | - Rose Du
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Rosalind Lai
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Gregory J Zipfel
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jason P Sheehan
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
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15
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Akamatsu Y, Gomez-Paz S, Vergara-Garcia D, Moholkar VM, Kuhn AL, Chida K, Singh J, Rodrigues KDM, Massari F, Moore JM, Puri AS, Ogilvy CS, Thomas AJ. Role of Surgical Intervention for Intracranial Dural Arteriovenous Fistulas With Cortical Venous Drainage in an Endovascular Era: A Case Series. Oper Neurosurg (Hagerstown) 2021; 20:364-372. [PMID: 33378448 DOI: 10.1093/ons/opaa423] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 10/09/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Intracranial dural arteriovenous fistulae (dAVFs) with cortical venous drainage (CVD) require treatment because of their aggressive clinical presentation and natural history. Although endovascular treatment is effective for the majority of these lesions in the current endovascular era, surgical management has been required if the lesions are not amenable to or fail endovascular treatments. OBJECTIVE To demonstrate the angioarchitecture that may necessitate surgical intervention. METHODS A retrospective review of the patients with intracranial dAVFs with CVD treated at 2 academic institutions between January 1, 2009, and July 31, 2019 was performed. Patients who required surgical intervention were selected in this study, and angiographic findings were analyzed. RESULTS A total of 81 dAVFs in 80 patients were treated during the study period. Endovascular treatments were attempted for 72 (88.9%) dAVFs, resulting in complete obliteration in 55 (76.4%). Surgical interventions were performed in 18 (22.2%) dAVFs, resulting in complete obliteration in all lesions. Overall, complete obliteration was achieved in 74 (93.7%) of 79 dAVFs with follow-up. In the surgically treated dAVFs, curative transarterial embolization was deterred by the angioarchitecture, which included dominant feeding vessels from the ophthalmic artery, meningohypophyseal trunk, posterior meningeal artery, pial artery, or ascending pharyngeal artery. Drainage through tortuous cortical vein, deep venous system, or isolated sinus made transvenous approach challenging. CONCLUSION Despite continued improvement in endovascular technology, surgical approaches to dAVFs are still of great value as initial and salvage treatment of dAVFs with angioarchitecture hampering endovascular treatment.
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Affiliation(s)
- Yosuke Akamatsu
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.,Department of Neurosurgery, Iwate Medical University, Yahaba, Japan
| | - Santiago Gomez-Paz
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - David Vergara-Garcia
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Viraj M Moholkar
- Division of Interventional Neuroradiology, Department of Radiology, University of Massachusetts Medical Center, Worcester, Massachusetts
| | - Anna Luisa Kuhn
- Division of Interventional Neuroradiology, Department of Radiology, University of Massachusetts Medical Center, Worcester, Massachusetts
| | - Kohei Chida
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.,Department of Neurosurgery, Iwate Medical University, Yahaba, Japan
| | - Jasmeet Singh
- Division of Interventional Neuroradiology, Department of Radiology, University of Massachusetts Medical Center, Worcester, Massachusetts
| | - Katyucia de Macedo Rodrigues
- Division of Interventional Neuroradiology, Department of Radiology, University of Massachusetts Medical Center, Worcester, Massachusetts
| | - Francesco Massari
- Division of Interventional Neuroradiology, Department of Radiology, University of Massachusetts Medical Center, Worcester, Massachusetts
| | - Justin M Moore
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Ajit S Puri
- Division of Interventional Neuroradiology, Department of Radiology, University of Massachusetts Medical Center, Worcester, Massachusetts
| | - Christopher S Ogilvy
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Ajith J Thomas
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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16
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Clinical and radiological response of aggressive dural arteriovenous fistula after combined glue embolization and hypofractionated helical TomoTherapy. JOURNAL OF RADIOTHERAPY IN PRACTICE 2021. [DOI: 10.1017/s1460396921000339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Abstract
Purpose:
We reported the clinical and radiological outcome of an aggressive dural arteriovenous fistula (DAVF) after combined glue embolization and hypofractionated helical TomoTherapy (Hypo-HT).
Materials and methods:
Eleven patients whose radiological examinations are consistent with aggressive DAVF were treated with combined glue embolization and Hypo-HT 30–36 Gy in 5–6 fractions. The dosimetric analysis, clinical response and radiological imaging obliteration rate by magnetic resonance angiography or computed tomography angiography were investigated.
Results:
There were eight males and three females with a male and female ratio of 2·67. The mean age was 51·2 years old (range 37–69). Anatomical imaging sites of disease included transverse-sigmoid sinuses (n = 7), superior sagittal sinus (n = 3) and tentorium cerebelli (n = 1). The mean pitch and MF of treatment plans were 0·273 ± 0·032 and 1·70 ± 0·31, respectively. The average size of PTV were 15·39 ± 7·74 cc whereas the Reff,PTV was 1·50 ± 0·25 cm. The average Dmax and Dmin were 37·52 ± 3·34 and 31·77 ± 2·64 Gy, respectively. HI, CI and CI50 were 0·16 ± 0·06, 1·80 ± 0·56 and 7·85 ± 4·16, respectively. The R
eff,Rx
and R
eff,50%Rx
were 1·80 ± 0·24 and 2·90 ± 0·45 cm, respectively. The R
eff
between 50%Rx and 100%Rx was 1·10 ± 0·28 cm on average. With a mean follow up of 28·5 months (range 9–48), the complete recovery of symptoms was found in 72·7 % (eight patients) within 2–12 months after completion Hypo-HT. Partial recovery was reported in 18·2% (two patients). No clinical response was found in 9·1% (one patient). The total radiographic obliteration rate was 27·3% (three patients), subtotal obliteration was 27·3% (three patients) and partial obliteration was 45·4% (five patients).
Conclusions:
Satisfactory clinical response of aggressive DAVF was found in all treated patients by combining glue embolization and Hypo-HT. All dosimetric parameters were acceptable. We still need an extended follow up time to assess further radiographic obliteration rate and late side effects of the treatment.
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17
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Maglinger B, Hulou MM, McLouth CJ, Sands M, Pokhrel D, St Clair WH, Grupke S, Fraser JF. Changes in Angioarchitecture After Stereotactic Radiosurgery for Dural Arteriovenous Fistula. J Stroke Cerebrovasc Dis 2021; 30:105676. [PMID: 33640784 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105676] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 01/24/2021] [Accepted: 02/06/2021] [Indexed: 10/22/2022] Open
Abstract
INTRODUCTION Dural arteriovenous fistulae (DAVF) are intracranial vascular abnormalities encountered in neurosurgery practice. Treatment options are microsurgical disconnection, endovascular embolization and/or radiosurgery. Past studies have reported the efficacy, safety, and predictors of success of radiosurgery. In this study, we investigated the angioarchitecture of fistulae at the time of radiosurgery and how the anatomy changed in the time after treatment based on angiogram follow-ups. METHODS A retrospective analysis was performed on patients with angiographic diagnosis of DAVF treated with Gamma Knife radiosurgery (GKRS) between 2013 and 2018. Data collection included demographics, symptoms, grading scores, vascular anatomy, radiation data, treatment strategy, angiographic results, and length of patient follow-up. RESULTS Our study reports data on 10 patients with a total of 14 fistulae. On follow-up angiography, 8 (57%) had complete occlusion of the fistula with a median time to follow up of 19.5 months. The remaining 6 (43%) were deemed as near-complete occlusion of fistula with a median time to follow up of 12.0 months. Time from radiosurgery to angiogram revealing incomplete vs. angiogram revealing complete obliteration was significantly different (p=0.045). Nearly all AVFs had decreased feeders over time after treatment with only one AVF developing an additional feeder post-treatment. Arterial feeders, drainage site, sex, Borden type, lesion volume and treatment volume had no predictive value of obliteration outcome. CONCLUSIONS This study provides data on the angioarchitecture of fistulae treated with GKRS and also serves as an extension of previous studies reporting the safety and efficacy of GKRS treatment for DAVF in a specific patient population.
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Affiliation(s)
| | - M Maher Hulou
- Department of Neurosurgery, University of Kentucky, Lexington, KY, USA
| | | | - Madison Sands
- University of Kentucky College of Medicine, Lexington, KY, USA
| | - Damodar Pokhrel
- Department of Radiation Oncology, University of Kentucky, Lexington, KY, USA
| | - William H St Clair
- Department of Radiation Oncology, University of Kentucky, Lexington, KY, USA
| | - Stephen Grupke
- Neurosurgery and Neuroendovascular surgery, Covenant Medical Center, Lubbock, USA
| | - Justin F Fraser
- Department of Neurosurgery, University of Kentucky, Lexington, KY, USA; Department of Neurology, University of Kentucky, Lexington, KY, USA; Department of Radiology, University of Kentucky, Lexington, KY, USA; Department of Neuroscience, University of Kentucky, Lexington, KY, USA.
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18
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Mohammed N, Hung YC, Chen CJ, Xu Z, Schlesinger D, Kano H, Chiang V, Hess J, Lee J, Mathieu D, Kaufmann AM, Grills IS, Cifarelli CP, Vargo JA, Chytka T, Janouskova L, Feliciano CE, Mercado RR, Lunsford LD, Sheehan JP. A Proposed Grading Scale for Predicting Outcomes After Stereotactic Radiosurgery for Dural Arteriovenous Fistulas. Neurosurgery 2020; 87:247-255. [PMID: 31584074 DOI: 10.1093/neuros/nyz401] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 07/18/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND There are presently no grading scales that specifically address the outcomes of cranial dural arteriovenous fistula (dAVF) after stereotactic radiosurgery (SRS). OBJECTIVE To design a practical grading system that would predict outcomes after SRS for cranial dAVFs. METHODS From the International Radiosurgery Research Foundation (University of Pittsburgh [41 patients], University of Pennsylvania [6 patients], University of Sherbrooke [2 patients], University of Manitoba [1 patient], West Virginia University [2 patients], University of Puerto Rico [1 patient], Beaumont Health System 1 [patient], Na Homolce Hospital [13 patients], the University of Virginia [48 patients], and Yale University [6 patients]) centers, 120 patients with dAVF treated with SRS were included in the study. The factors predicting favorable outcome (obliteration without post-SRS hemorrhage) after SRS were assessed using logistic regression analysis. These factors were pooled with the factors that were found to be predictive of obliteration from 7 studies with 736 patients after a systematic review of literature. These were entered into stepwise multiple regression and the best-fit model was identified. RESULTS Based on the predictive model, 3 factors emerged to develop an SRS scoring system: cortical venous reflux (CVR), prior intracerebral hemorrhage (ICH), and noncavernous sinus location. Class I (score of 0-1 points) predicted the best favorable outcome of 80%. Class II patients (2 points score) had an intermediate favorable outcome of 57%, and class III (score 3 points) had the least favorable outcome at 37%. The ROC analysis showed better predictability to prevailing grading systems (AUC = 0.69; P = .04). Kaplan-Meier analysis showed statistically significant difference between the 3 subclasses of the proposed grading system for post-SRS dAVF obliteration (P = .001). CONCLUSION The proposed dAVF grading system incorporates angiographic, anatomic, and clinical parameters and improves the prediction of the outcomes following SRS for dAVF as compared to the existing scoring systems.
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Affiliation(s)
- Nasser Mohammed
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
| | - Yi-Chieh Hung
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
| | - Ching-Jen Chen
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
| | - Zhiyuan Xu
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
| | - David Schlesinger
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
| | - Hideyuki Kano
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Judith Hess
- School of Medicine, Yale University, New Haven, Connecticut
| | - John Lee
- Department of Neurological Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - David Mathieu
- Department of Neurological Surgery, Université de Sherbrooke, Centre de recherche du CHUS, Sherbrooke, Canada
| | - Anthony M Kaufmann
- Department of Neurological Surgery, University of Manitoba, Winnipeg, Canada
| | - Inga S Grills
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, Michigan
| | | | - John A Vargo
- Department of Neurological Surgery, West Virginia University, Morgantown, West Virginia
| | - Tomas Chytka
- Department of Neurological Surgery, Na Homolce Hospital, Prague, Czech Republic
| | | | - Caleb E Feliciano
- Department of Neurological Surgery, University of Puerto Rico, San Juan, Puerto Rico
| | | | - L Dade Lunsford
- Department of Neurological Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jason P Sheehan
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
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19
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Hung YC, Mohammed N, Kearns KN, Chen CJ, Starke RM, Kano H, Lee J, Mathieu D, Kaufmann AM, Wang WG, Grills IS, Cifarelli CP, Vargo J, Chytka T, Janouskova L, Feliciano CE, Rodriguez-Mercado R, Lunsford LD, Sheehan JP. Stereotactic Radiosurgery for Cavernous Sinus Versus Noncavernous Sinus Dural Arteriovenous Fistulas: Outcomes and Outcome Predictors. Neurosurgery 2020; 86:676-684. [PMID: 31384943 DOI: 10.1093/neuros/nyz260] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 04/16/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Dural arteriovenous fistulas (DAVFs) can be categorized based on location. OBJECTIVE To compare stereotactic radiosurgery (SRS) outcomes between cavernous sinus (CS) and non-CS DAVFs and to identify respective outcome predictors. METHODS This is a retrospective study of DAVFs treated with SRS between 1988 and 2016 at 10 institutions. Patients' variables, DAVF characters, and SRS parameters were included for analyses. Favorable clinical outcome was defined as angiography-confirmed obliteration without radiological radiation-induced changes (RIC) or post-SRS hemorrhage. Other outcomes were DAVFs obliteration and adverse events (including RIC, symptomatic RIC, and post-SRS hemorrhage). RESULTS The overall study cohort comprised 131 patients, including 20 patients with CS DAVFs (15%) and 111 patients with non-CS DAVFs (85%). Rates of favorable clinical outcome were comparable between the 2 groups (45% vs 37%, P = .824). Obliteration rate after SRS was higher in the CS DAVFs group, even adjusted for baseline difference (OR = 4.189, P = .044). Predictors of favorable clinical outcome included higher maximum dose (P = .014) for CS DAVFs. Symptomatic improvement was associated with obliteration in non-CS DAVFs (P = .005), but symptoms improved regardless of whether obliteration was confirmed in CS DAVFs. Non-CS DAVFs patients with adverse events after SRS were more likely to be male (P = .020), multiple arterial feeding fistulas (P = .018), and lower maximum dose (P = .041). CONCLUSION After SRS, CS DAVFs are more likely to obliterate than non-CS ones. Because these 2 groups have different total predictors for clinical and radiologic outcomes after SRS, they should be considered as different entities.
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Affiliation(s)
- Yi-Chieh Hung
- Division of Neurosurgery, Department of Surgery, Chi-Mei Medical Center, Tainan, Taiwan.,Department of Recreation and Healthcare Management, Chia Nan University of Pharmacy and Science, Tainan, Taiwan.,Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
| | - Nasser Mohammed
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
| | - Kathryn N Kearns
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
| | - Ching-Jen Chen
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
| | - Robert M Starke
- Department of Neurological Surgery, University of Miami, Miami, Florida
| | - Hideyuki Kano
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - John Lee
- Department of Neurological Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - David Mathieu
- Department of Neurological Surgery, Université de Sherbrooke, Centre de recherche du CHUS, Sherbrooke, Canada
| | - Anthony M Kaufmann
- Department of Neurological Surgery, University of Manitoba, Winnipeg, Canada
| | - Wei Gang Wang
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, Michigan
| | - Inga S Grills
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, Michigan
| | | | - John Vargo
- Department of Radiation Oncology, West Virginia University, Morgantown, West Virginia
| | - Tomas Chytka
- Department of Neurological Surgery, Na Homolce Hospital, Prague, Czech Republic
| | | | - Caleb E Feliciano
- Department of Neurological Surgery, University of Puerto Rico, San Juan, Puerto Rico
| | | | - L Dade Lunsford
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jason P Sheehan
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
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20
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Ding K, Romiyo P, Ng E, Udawatta M, Dejam D, Phillips HW, Sun MZ, Yang I. A systematic analysis of stereotactic radiosurgery surveys for residents in neurosurgery training programs. J Neurol Sci 2020; 417:116867. [PMID: 32423574 DOI: 10.1016/j.jns.2020.116867] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 04/26/2020] [Indexed: 10/24/2022]
Abstract
OBJECT The use of stereotactic radiosurgery (SRS) has increased. SRS training has not risen congruently. Neurosurgeons have conducted surveys and advocated implementation of widespread, standardized radiosurgery training. Here we analyze the SRS surveys conducted throughout the past decade. METHODS This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for systematic literature review. A broad search of the literature was conducted in October 2018 through the PubMed, Scopus, Embase, and Web of Science databases. This study included surveys evaluating SRS training in neurosurgery and excluded those regarding other specialties. RESULTS An overview of surveys showed that neurosurgery residents possess gaps in SRS knowledge and procedural competency that have persisted through the past decade. There is an overwhelming sentiment that current radiosurgery training is not adequate to prepare residents for future practice. Our recommendation is for residency programs to integrate formal SRS training electives, with a movement towards creating more options for extended SRS fellowships post-residency. CONCLUSIONS We present data from SRS competency and current training surveys. Although resident SRS training still lags behind other subspecialties, we see indications for growth. To keep up with the role of SRS in neurosurgery, residencies need more formalized SRS rotations.
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Affiliation(s)
- Kevin Ding
- Departments of Neurosurgery, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA
| | - Prasanth Romiyo
- Departments of Neurosurgery, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA
| | - Edwin Ng
- Departments of Neurosurgery, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA
| | - Methma Udawatta
- Departments of Neurosurgery, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA
| | - Dillon Dejam
- Departments of Neurosurgery, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA
| | - H Westley Phillips
- Departments of Neurosurgery, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA
| | - Matthew Z Sun
- Departments of Neurosurgery, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA
| | - Isaac Yang
- Departments of Neurosurgery, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA; Office of the Patient Experience, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA; Radiation Oncology, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA; Head and Neck Surgery, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA; UCLA Jonsson Comprehensive Cancer Center, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA; Department of Neurosurgery at Harbor-UCLA Medical Center, Torrance, CA, USA; Los Angeles Biomedical Research Institute (LA BioMed) at Harbor-UCLA Medical Center, Torrance, CA, USA.
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21
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Sardana H, Agrawal D, Manjunath N. Gamma Knife Radiosurgery: The Gold Standard Treatment for Intracranial Dural Arteriovenous Fistulas without Cortical Venous Drainage. Neurol India 2020; 68:815-820. [PMID: 32859819 DOI: 10.4103/0028-3886.293482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Context Endovascular therapy is currently the most common treatment approach for intracranial dural arteriovenous fistula (DAVF), followed by microsurgery. Gamma Knife radiosurgery (GKS) is usually reserved as the last modality of treatment of intracranial DAVF. Aim To evaluate the clinical and radiological outcome of GKS in the treatment of DAVF without CVD. Subjects and Methods This series includes patients who underwent GKS for intracranial DAVF without CVD over 10 years (Jan 2007 to Dec 2016) in All India Institute of Medical Sciences, New Delhi. Their demographic profile, clinical presentation, imaging details, GKS details, and follow-up clinical status were obtained retrospectively. Clinical follow-up, along with radiological assessment using MRI every 6 months was done after GKS. DSA was performed once MRI strongly suggested obliteration of DAVF. Patients who had a clinical follow-up of less than 1 year were excluded from the study. Results 5 patients (4 males and 1 female) who had DAVF without CVD were included the study. The mean age was 44.8 years. All patients had complete obliteration of fistula on digital subtraction angiography (DSA) at a mean duration of 24 months post GKS. All patients had complete resolution of symptoms at the last follow-up. Conclusions Gamma Knife surgery is the most effective and the safest treatment modality for dealing with DAVFs without CVD. Instead of reserving it as the last resort for patients with DAVF without CVD, it should be considered as the gold standard treatment for DAVFs without CVD.
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Affiliation(s)
- Hardik Sardana
- Department of Neurosurgery, All Institute of Medical Sciences, New Delhi, India
| | - Deepak Agrawal
- Department of Neurosurgery, All Institute of Medical Sciences, New Delhi, India
| | - Niveditha Manjunath
- Department of Neurosurgery, All Institute of Medical Sciences, New Delhi, India
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22
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Vollherbst DF, Bendszus M, Möhlenbruch MA. Vascular Malformations of the Brain and Its Coverings. JOURNAL OF NEUROENDOVASCULAR THERAPY 2020; 14:285-294. [PMID: 37502170 PMCID: PMC10370599 DOI: 10.5797/jnet.ra.2020-0020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 04/19/2020] [Indexed: 07/29/2023]
Abstract
Vascular malformations of the brain and its coverings encompass several different vascular pathologies of the brain and its coverings, which substantially differ in morphology, clinical presentation, and prognosis, reaching from incidental, asymptomatic vascular abnormalities to life-threatening diseases with high risks of morbidity, most frequently caused by intracranial hemorrhage. In this article, the most common vascular malformations of the brain with and without arteriovenous shunting of blood (e.g., arteriovenous malformations [AVMs], dural arteriovenous fistulas [DAVFs], and cavernous malformations) are explained with a focus on definition, diagnosis, classification, and management.
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Affiliation(s)
- Dominik F Vollherbst
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Martin Bendszus
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Markus A Möhlenbruch
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
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23
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Wallach AI, Kister I, Raz E. Clinical Reasoning: A 63-year-old man with gastroenteritis progressing to stupor and quadriparesis. Neurology 2020; 94:e1107-e1111. [DOI: 10.1212/wnl.0000000000009057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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24
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Complication rate, cure rate, and long-term outcomes of microsurgery for intracranial dural arteriovenous fistulae: a multicenter series and systematic review. Neurosurg Rev 2020; 44:435-450. [PMID: 31897884 DOI: 10.1007/s10143-019-01232-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 11/17/2019] [Accepted: 12/26/2019] [Indexed: 10/25/2022]
Abstract
Although microsurgery is an established treatment modality for intracranial dural arteriovenous fistula (dAVF), data regarding the perioperative complication rate, cure rate, and long-term outcomes remain scarce. The aims of this study were to describe our original experience with microsurgery, including the surgical complications and pitfalls, and conduct a systematic review of the relevant literature. A multicenter cohort of patients with dAVF treated by microsurgery was retrospectively assessed. In addition, the PubMed database was searched for published studies involving microsurgery for dAVF, and the complication rate, cure rate, and long-term outcomes were estimated. The total number of patients in our multicenter series and published articles was 553 (593 surgeries). The overall rates of transient complications, permanent complications, death, and incomplete treatment were 11.4, 4.0, 1.2, and 6.5%, respectively. A favorable outcome was achieved for 90.1% patients, even though almost half of the patients presented with intracranial hemorrhage. Of note, the incidence of recurrence was only one per 8241 patient-months of postoperative follow-up. Surgeries for anterior cranial fossa dAVF were associated with a lower complication rate, whereas those for tentorial dAVF were associated with higher complication and incomplete treatment rates. The complication and incomplete treatment rates were lower with simple disconnection of cortical venous drainage than with radical occlusion/resection of dural shunts. Our findings suggest that the cure rate, complication rates, and outcomes of microsurgery for dAVF are acceptable; thus, it could be a feasible second-line treatment option for dAVF. However, surgeons should be aware of the specific adverse events of microsurgery.
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25
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Doi K, Otani N, Hayashi M, Takeuchi S, Toyooka T, Wada K, Mori K. Mixed pial and dural arteriovenous fistula after craniotomy: case report and literature review. Br J Neurosurg 2019:1-4. [PMID: 31597495 DOI: 10.1080/02688697.2019.1672860] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Dural arteriovenous fistula (AVF) is known to occur after craniotomy, but mixed pial and dural AVF after craniotomy has not been reported. A 45-year-old man who had undergone surgical clipping of an unruptured aneurysm 2 years previously presented with small subcortical hemorrhage from mixed pial and dural AVF. Surgical disconnection could not be cured completely due to the granulomatous tissue around the aneurysm, and the presence of an undetected shunt. Postoperative digital subtraction angiography showed a new pial AVF supplied by the middle cerebral artery pial branches. Many branches were associated with the remnant aneurysm and pial AVF, so we did not try to embolize the fistula. Gamma knife surgery was performed as adjuvant radiotherapy, which achieved angiographically complete occlusion of the shunt points. Multimodal approaches including surgery, endovascular intervention, and radiotherapy are needed for radiological and clinical cure of mixed pial and dural AVF. Long-term follow up is essential.
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Affiliation(s)
- Kazuma Doi
- Department of Neurosurgery, National Defense Medical College , Tokorozawa , Saitama , Japan
| | - Naoki Otani
- Department of Neurosurgery, National Defense Medical College , Tokorozawa , Saitama , Japan
| | - Motohiro Hayashi
- Department of Neurosurgery, Tokyo Women's Medical University , Tokyo , Japan
| | - Satoru Takeuchi
- Department of Neurosurgery, National Defense Medical College , Tokorozawa , Saitama , Japan
| | - Terushige Toyooka
- Department of Neurosurgery, National Defense Medical College , Tokorozawa , Saitama , Japan
| | - Kojiro Wada
- Department of Neurosurgery, National Defense Medical College , Tokorozawa , Saitama , Japan
| | - Kentaro Mori
- Department of Neurosurgery, National Defense Medical College , Tokorozawa , Saitama , Japan.,Department of Neurosurgery, Tokyo General Hospital , Tokyo , Japan
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26
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Yang HC, Lin CJ, Luo CB, Lee CC, Wu HM, Guo WY, Chung WY, Liu KD. Treatment Outcomes of Cavernous Sinus Dural Arteriovenous Fistulas: Comparison of Radiosurgery and Endovascular Embolisation. Clin Neuroradiol 2019; 30:321-330. [PMID: 31098665 DOI: 10.1007/s00062-019-00787-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 04/23/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE Endovascular treatment (EVT) and stereotaxic gamma-knife radiosurgery (GKRS) can both effectively treat cavernous sinus dural arteriovenous fistulas (CSDAVF). This study compared the prognostic factors and treatment effectiveness of GKRS and EVT for different CSDAVF types. METHODS The charts of 200 patients undergoing GKRS and 105 patients undergoing EVT were reviewed for data on symptoms (e.g. orbital, cavernous, ocular, and cerebral). The CSDAVFs were classified into proliferative, restrictive, and late restrictive types. The prognostic factors for complete obliteration (CO) were evaluated in both the GKRS and EVT groups and the latent period to CO was measured. For statistical analysis χ2-tests were used to compare final CO rates for EVT and GKRS across the three CSDAVF types. RESULTS The EVT and cavernous symptoms were significant independent predictors of CO. The CO rate after EVT (97.9%) was significantly higher than that after GKRS (63.5%) for restrictive CSDAVFs (P < 0.001) but not for proliferative or late restrictive types. In the GKRS group, cavernous symptoms (hazard ratio, HR: 0.557) and target volume (HR: 0.853) predicted CO, but only target volume remained significant in multivariate analysis. In the EVT group, the latent period to CO was shortest for restrictive CSDAVFs (3.2 ± 1.6 months, P = 0.05). CONCLUSION Angioarchitecture did not affect treatment outcomes. Cavernous symptoms were strongly associated with lower complete obliteration rates in the GKRS but not the EVT group. The EVT method remains the treatment of choice, especially for restrictive CSDAVFs; however, compared to EVT, GKRS had lower complication rates and similar therapeutic effects for proliferative type fistulas.
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Affiliation(s)
- Huai-Che Yang
- Neurologic Institute, Department of Neurosurgery, Taipei Veterans General Hospital, 201 Shipai Rd, Sec 2, Beitou District, 112, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming University, Taipei, Taiwan, ROC
| | - Chung-Jung Lin
- Department of Radiology, Taipei Veterans General Hospital, 201 Shipai Rd, Sec 2, Beitou District, 112, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming University, Taipei, Taiwan, ROC
| | - Chao-Bao Luo
- Department of Radiology, Taipei Veterans General Hospital, 201 Shipai Rd, Sec 2, Beitou District, 112, Taipei, Taiwan, ROC.
- School of Medicine, National Yang Ming University, Taipei, Taiwan, ROC.
- Department of Radiology, Tri-service General Hospital and National Defense Medical Center, Taipei, Taiwan, ROC.
| | - Cheng-Chia Lee
- Neurologic Institute, Department of Neurosurgery, Taipei Veterans General Hospital, 201 Shipai Rd, Sec 2, Beitou District, 112, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming University, Taipei, Taiwan, ROC
| | - Hsiu-Mei Wu
- Department of Radiology, Taipei Veterans General Hospital, 201 Shipai Rd, Sec 2, Beitou District, 112, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming University, Taipei, Taiwan, ROC
| | - Wan-Yuo Guo
- Department of Radiology, Taipei Veterans General Hospital, 201 Shipai Rd, Sec 2, Beitou District, 112, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming University, Taipei, Taiwan, ROC
| | - Wen-Yuh Chung
- Neurologic Institute, Department of Neurosurgery, Taipei Veterans General Hospital, 201 Shipai Rd, Sec 2, Beitou District, 112, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming University, Taipei, Taiwan, ROC
| | - Kang-Du Liu
- Neurologic Institute, Department of Neurosurgery, Taipei Veterans General Hospital, 201 Shipai Rd, Sec 2, Beitou District, 112, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming University, Taipei, Taiwan, ROC
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27
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Baek HG, Park SH, Park KS, Kang DH, Hwang JH, Hwang SK. Stereotactic Radiosurgery for Dural Arteriovenous Fistulas Involving the Transverse-Sigmoid Sinus : A Single Center Experience and Review of the Literatures. J Korean Neurosurg Soc 2019; 62:458-466. [PMID: 31064039 PMCID: PMC6616977 DOI: 10.3340/jkns.2018.0211] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 12/31/2018] [Indexed: 11/27/2022] Open
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.
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Affiliation(s)
- Hong-Gyu Baek
- Department of Neurosurgery, School of Medicine, Kyungpook National University, Daegu, Korea.,Department of Neurosurgery, Kyungpook National University Hospital, Daegu, Korea
| | - Seong-Hyun Park
- Department of Neurosurgery, School of Medicine, Kyungpook National University, Daegu, Korea.,Department of Neurosurgery, Kyungpook National University Hospital, Daegu, Korea
| | - Ki-Su Park
- Department of Neurosurgery, School of Medicine, Kyungpook National University, Daegu, Korea.,Department of Neurosurgery, Kyungpook National University Hospital, Daegu, Korea
| | - Dong-Hun Kang
- Department of Neurosurgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jeong-Hyun Hwang
- Department of Neurosurgery, School of Medicine, Kyungpook National University, Daegu, Korea.,Department of Neurosurgery, Kyungpook National University Hospital, Daegu, Korea
| | - Sung-Kyoo Hwang
- Department of Neurosurgery, School of Medicine, Kyungpook National University, Daegu, Korea.,Department of Neurosurgery, Kyungpook National University Hospital, Daegu, Korea
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28
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Wu CA, Yang HC, Hu YS, Wu HM, Lin CJ, Luo CB, Guo WY, Lee CC, Liu KD, Chung WY. Venous outflow restriction as a predictor of cavernous sinus dural arteriovenous fistula obliteration after Gamma Knife surgery. J Neurosurg 2019; 132:132-139. [PMID: 30684940 DOI: 10.3171/2018.9.jns182040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 09/28/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Gamma Knife surgery (GKS) obliterates 65%-87% of cavernous sinus dural arteriovenous fistulas (CSDAVFs). However, the hemodynamic effect on GKS outcomes is relatively unknown. The authors thus used the classification scheme developed by Suh et al. to explore this effect. METHODS The authors retrospectively (1993-2016) included 123 patients with CSDAVFs who received GKS alone at the institute and classified them as proliferative type (PT; n = 23), restrictive type (RT; n = 61), or late restrictive type (LRT; n = 39) after analyzing their pre-GKS angiography images. Treatment parameters, the presence of numerous arterial feeders, and venous drainage numbers were compared across the CSDAVF types. Patients' follow-up MR images were evaluated for the presence of complete obliteration. A Kaplan-Meier analysis was conducted to determine the correlation between CSDAVF types and outcomes. RESULTS The 36-month probability of complete obliteration was 74.3% for all patients, with no significant differences across types (p = 0.56). PT had the largest radiation volume (6.5 cm3, p < 0.001), the most isocenters (5, p = 0.015) and venous drainage routes (3, p < 0.001), and the lowest peripheral dose (16.6 Gy, p = 0.011) and isodose level coverage (64.3%, p = 0.006). CSDAVFs presenting with ocular patterns were less likely to be completely obliterated (hazard ratio 0.531, p = 0.009). After adjustment for age, CSDAVFs with more venous drainage routes were less likely to be completely obliterated (hazard ratio 0.784, p = 0.039). CONCLUSIONS GKS is an equally effective treatment option for all 3 CSDAVF types. Furthermore, the number of venous drainage routes may help in predicting treatment outcomes and making therapeutic decisions.
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Affiliation(s)
- Chia-An Wu
- 1Department of Radiology
- 3School of Medicine, National Yang-Ming University, Taipei, Taiwan (ROC)
| | - Huai-Che Yang
- 2Neurological Institute, Department of Neurosurgery, Taipei Veterans General Hospital; and
- 3School of Medicine, National Yang-Ming University, Taipei, Taiwan (ROC)
| | - Yong-Sin Hu
- 1Department of Radiology
- 3School of Medicine, National Yang-Ming University, Taipei, Taiwan (ROC)
| | - Hsiu-Mei Wu
- 1Department of Radiology
- 3School of Medicine, National Yang-Ming University, Taipei, Taiwan (ROC)
| | - Chung-Jung Lin
- 1Department of Radiology
- 3School of Medicine, National Yang-Ming University, Taipei, Taiwan (ROC)
| | - Chao-Bao Luo
- 1Department of Radiology
- 3School of Medicine, National Yang-Ming University, Taipei, Taiwan (ROC)
| | - Wan-Yuo Guo
- 1Department of Radiology
- 3School of Medicine, National Yang-Ming University, Taipei, Taiwan (ROC)
| | - Cheng-Chia Lee
- 2Neurological Institute, Department of Neurosurgery, Taipei Veterans General Hospital; and
- 3School of Medicine, National Yang-Ming University, Taipei, Taiwan (ROC)
| | - Kang-Du Liu
- 2Neurological Institute, Department of Neurosurgery, Taipei Veterans General Hospital; and
- 3School of Medicine, National Yang-Ming University, Taipei, Taiwan (ROC)
| | - Wen-Yuh Chung
- 2Neurological Institute, Department of Neurosurgery, Taipei Veterans General Hospital; and
- 3School of Medicine, National Yang-Ming University, Taipei, Taiwan (ROC)
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Starke RM, McCarthy DJ, Chen CJ, Kano H, McShane B, Lee J, Mathieu D, Vasas LT, Kaufmann AM, Wang WG, Grills IS, Patibandla MR, Cifarelli CP, Paisan G, Vargo JA, Chytka T, Janouskova L, Feliciano CE, Rodriguez-Mercado R, Tonetti DA, Lunsford LD, Sheehan JP. Evaluation of stereotactic radiosurgery for cerebral dural arteriovenous fistulas in a multicenter international consortium. J Neurosurg 2019; 132:114-121. [PMID: 30611144 PMCID: PMC6609496 DOI: 10.3171/2018.8.jns181467] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Accepted: 08/16/2018] [Indexed: 11/12/2022]
Abstract
OBJECTIVE In this multicenter study, the authors reviewed the results obtained in patients who underwent Gamma Knife radiosurgery (GKRS) for dural arteriovenous fistulas (dAVFs) and determined predictors of outcome. METHODS Data from a cohort of 114 patients who underwent GKRS for cerebral dAVFs were compiled from the International Gamma Knife Research Foundation. Favorable outcome was defined as dAVF obliteration and no posttreatment hemorrhage or permanent symptomatic radiation-induced complications. Patient and dAVF characteristics were assessed to determine predictors of outcome in a multivariate logistic regression analysis; dAVF-free obliteration was calculated in a competing-risk survival analysis; and Youden indices were used to determine optimal radiosurgical dose. RESULTS A mean margin dose of 21.8 Gy was delivered. The mean follow-up duration was 4 years (range 0.5-18 years). The overall obliteration rate was 68.4%. The postradiosurgery actuarial rates of obliteration at 3, 5, 7, and 10 years were 41.3%, 61.1%, 70.1%, and 82.0%, respectively. Post-GRKS hemorrhage occurred in 4 patients (annual risk of 0.9%). Radiation-induced imaging changes occurred in 10.4% of patients; 5.2% were symptomatic, and 3.5% had permanent deficits. Favorable outcome was achieved in 63.2% of patients. Patients with middle fossa and tentorial dAVFs (OR 2.4, p = 0.048) and those receiving a margin dose greater than 23 Gy (OR 2.6, p = 0.030) were less likely to achieve a favorable outcome. Commonly used grading scales (e.g., Borden and Cognard) were not predictive of outcome. Female sex (OR 1.7, p = 0.03), absent venous ectasia (OR 3.4, p < 0.001), and cavernous carotid location (OR 2.1, p = 0.019) were predictors of GKRS-induced dAVF obliteration. CONCLUSIONS GKRS for cerebral dAVFs achieved obliteration and avoided permanent complications in the majority of patients. Those with cavernous carotid location and no venous ectasia were more likely to have fistula obliteration following radiosurgery. Commonly used grading scales were not reliable predictors of outcome following radiosurgery.
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Affiliation(s)
- Robert M. Starke
- Department of Neurological Surgery, University of Miami, Florida
| | | | - Ching-Jen Chen
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
| | - Hideyuki Kano
- Department of Neurological Surgery, University of Pittsburgh
| | - Brendan McShane
- Department of Neurological Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - John Lee
- Department of Neurological Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - David Mathieu
- Department of Neurological Surgery, University of Sherbrooke, Quebec
| | - Lucas T. Vasas
- Department of Neurological Surgery, University of Manitoba, Winnipeg, Canada
| | - Anthony M. Kaufmann
- Department of Neurological Surgery, University of Manitoba, Winnipeg, Canada
| | - Wei Gang Wang
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, Michigan
| | - Inga S. Grills
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, Michigan
| | - Mohana Rao Patibandla
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
| | | | - Gabriella Paisan
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
| | - John A. Vargo
- Department of Radiation Oncology, West Virginia University, Morgantown, West Virginia
| | - Tomas Chytka
- Department of Neurological Surgery, Na Homolce Hospital, Prague, Czech Republic
| | | | - Caleb E. Feliciano
- Department of Neurological Surgery, University of Puerto Rico, San Juan, Puerto Rico
| | | | | | | | - Jason P. Sheehan
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
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Vollherbst DF, Bendszus M, Möhlenbruch MA. [Intracranial vascular malformations]. DER NERVENARZT 2018; 89:1179-1194. [PMID: 30215133 DOI: 10.1007/s00115-018-0606-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Intracranial vascular malformations range from incidental asymptomatic vascular alterations up to life-threatening vascular disorders. Arteriovenous malformations and dural arteriovenous fistulas are cerebral vascular malformations with arteriovenous shunting of blood. In the majority of cases they are accompanied by an elevated risk of intracerebral hemorrhage and can cause severe symptoms. They can be treated conservatively or interventionally via microneurosurgery, endovascular embolization and radiation therapy. Cavernous malformations, developmental venous anomalies (DVA) and capillary telangiectasia are cerebral vascular malformations without arteriovenous shunting. Cavernous malformations are rarely symptomatic in the form of cerebral hemorrhage, headache or seizures and in such cases an operative treatment can be indicated. The DVA and capillary telangiectasia are usually asymptomatic and do not require treatment.
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Affiliation(s)
- D F Vollherbst
- Abteilung für Neuroradiologie, Neurologische Klinik, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland
| | - M Bendszus
- Abteilung für Neuroradiologie, Neurologische Klinik, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland
| | - M A Möhlenbruch
- Abteilung für Neuroradiologie, Neurologische Klinik, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland.
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Eskey CJ, Meyers PM, Nguyen TN, Ansari SA, Jayaraman M, McDougall CG, DeMarco JK, Gray WA, Hess DC, Higashida RT, Pandey DK, Peña C, Schumacher HC. Indications for the Performance of Intracranial Endovascular Neurointerventional Procedures: A Scientific Statement From the American Heart Association. Circulation 2018; 137:e661-e689. [PMID: 29674324 DOI: 10.1161/cir.0000000000000567] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Intracranial endovascular interventions provide effective and minimally invasive treatment of a broad spectrum of diseases. This area of expertise has continued to gain both wider application and greater depth as new and better techniques are developed and as landmark clinical studies are performed to guide their use. Some of the greatest advances since the last American Heart Association scientific statement on this topic have been made in the treatment of ischemic stroke from large intracranial vessel occlusion, with more effective devices and large randomized clinical trials showing striking therapeutic benefit. The treatment of cerebral aneurysms has also seen substantial evolution, increasing the number of aneurysms that can be treated successfully with minimally invasive therapy. Endovascular therapies for such other diseases as arteriovenous malformations, dural arteriovenous fistulas, idiopathic intracranial hypertension, venous thrombosis, and neoplasms continue to improve. The purpose of the present document is to review current information on the efficacy and safety of procedures used for intracranial endovascular interventional treatment of cerebrovascular diseases and to summarize key aspects of best practice.
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Buell TJ, Raper DM, Ding D, Chen CJ, Liu KC. Development of an Intracranial Dural Arteriovenous Fistula after Venous Sinus Stenting for Idiopathic Intracranial Hypertension. J Neurointerv Surg 2018; 10:e15. [PMID: 29563208 DOI: 10.1136/neurintsurg-2017-013282.rep] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 08/07/2017] [Accepted: 08/08/2017] [Indexed: 11/04/2022]
Abstract
We report a case in which an intracranial dural arteriovenous fistula (DAVF) developed after endovascular treatment of a patient with idiopathic intracranial hypertension with venous sinus stenting (VSS). The pathogenesis may involve hemodynamic alterations secondary to increased poststenting venous sinus pressure, which may cause new arterial ingrowth into the fistulous sinus wall without capillary interposition. Despite administration of dual antiplatelet therapy, there may also be subclinical cortical vein thrombosis that contributed to DAVF formation. In addition to the aforementioned mechanisms, increased inflammation induced by VSS may upregulate vascular endothelial growth factor and platelet-derived growth factor expression and also promote DAVF pathogenesis. Since VSS has been used to obliterate DAVFs, DAVF formation after VSS may seem counterintuitive. Previous stents have generally been closed cell, stainless steel designs used to maximize radial compression of the fistulous sinus wall. In contrast, our patient's stent was an open cell, self-expandable nitinol design (Protégé Everflex). Neurointerventionalists should be aware of this potential, although rare complication of DAVF formation after VSS.
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Affiliation(s)
- Thomas J Buell
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA
| | - Daniel M Raper
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA
| | - Dale Ding
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA
| | - Ching-Jen Chen
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA
| | - Kenneth C Liu
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA
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Tonetti DA, Gross BA, Jankowitz BT, Kano H, Monaco EA, Niranjan A, Flickinger JC, Lunsford LD. Reconsidering an important subclass of high-risk dural arteriovenous fistulas for stereotactic radiosurgery. J Neurosurg 2018; 130:972-976. [PMID: 29547086 DOI: 10.3171/2017.10.jns171802] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Accepted: 10/03/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Aggressive dural arteriovenous fistulas (dAVFs) with cortical venous drainage (CVD) are known for their relatively high risk of recurrent neurological events or hemorrhage. However, recent natural history literature has indicated that nonaggressive dAVFs with CVD have a significantly lower prospective risk of hemorrhage. These nonaggressive dAVFs are typically diagnosed because of symptomatic headache, pulsatile tinnitus, or ocular symptoms, as in low-risk dAVFs. Therefore, the viability of stereotactic radiosurgery (SRS) as a treatment for this lesion subclass should be investigated. METHODS The authors evaluated their institutional experience with SRS for dAVFs with CVD for the period from 1991 to 2016, assessing angiographic outcomes and posttreatment hemorrhage rates. They subsequently pooled their results with those published in the literature and stratified the results based on the mode of clinical presentation. RESULTS In an institutional cohort of 42 dAVFs with CVD treated using SRS, there were no complications or hemorrhages after treatment in 19 patients with nonaggressive dAVFs, but there was 1 radiation-induced complication and 1 hemorrhage among the 23 patients with aggressive dAVFs. In pooling these cases with 155 additional cases from the literature, the authors found that the hemorrhage rate after SRS was significantly lower among the patients with nonaggressive dAVFs (0% vs 6.8%, p = 0.003). Similarly, the number of radiation-related complications was 0/124 in nonaggressive dAVF cases versus 6/73 in aggressive dAVF cases (p = 0.001). The annual rate of hemorrhage after SRS for aggressive fistulas was 3.0% over 164.5 patient-years, whereas none of the nonaggressive fistulas bled after radiosurgery over 279.4 patient-years of follow-up despite the presence of CVD. CONCLUSIONS Cortical venous drainage is thought to be a significant risk factor in all dAVFs. In the institutional experience described here, SRS proved to be a low-risk strategy associated with a very low risk of subsequent hemorrhage or radiation-related complications in nonaggressive dAVFs with CVD.
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Affiliation(s)
- Daniel A Tonetti
- 1Center for Image-Guided Neurosurgery and
- Departments of2Neurological Surgery and
| | - Bradley A Gross
- 1Center for Image-Guided Neurosurgery and
- Departments of2Neurological Surgery and
| | - Brian T Jankowitz
- 1Center for Image-Guided Neurosurgery and
- Departments of2Neurological Surgery and
| | - Hideyuki Kano
- 1Center for Image-Guided Neurosurgery and
- Departments of2Neurological Surgery and
| | - Edward A Monaco
- 1Center for Image-Guided Neurosurgery and
- Departments of2Neurological Surgery and
| | - Ajay Niranjan
- 1Center for Image-Guided Neurosurgery and
- Departments of2Neurological Surgery and
| | - John C Flickinger
- 1Center for Image-Guided Neurosurgery and
- 3Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - L Dade Lunsford
- 1Center for Image-Guided Neurosurgery and
- Departments of2Neurological Surgery and
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Hull JE, Jennings WC, Cooper RI, Waheed U, Schaefer ME, Narayan R. The Pivotal Multicenter Trial of Ultrasound-Guided Percutaneous Arteriovenous Fistula Creation for Hemodialysis Access. J Vasc Interv Radiol 2018; 29:149-158.e5. [DOI: 10.1016/j.jvir.2017.10.015] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 09/13/2017] [Accepted: 10/15/2017] [Indexed: 11/26/2022] Open
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35
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Nishimuta Y, Awa R, Sugata S, Nagayama T, Makiuchi T, Tomosugi T, Hanaya R, Tokimura H, Hirano H, Moinuddin FM, Kamil M, Kibe A, Arita K. Long-term outcome after endovascular treatment of cavernous sinus dural arteriovenous fistula and a literature review. Acta Neurochir (Wien) 2017; 159:2113-2122. [PMID: 28932918 DOI: 10.1007/s00701-017-3336-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 09/12/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND The long-term efficacy of endovascular treatment (EVT) for cavernous sinus dural arteriovenous fistulae (CS-dAVF) was assessed with a special focus on residual shunts after initial EVT. PATIENTS AND METHODS This retrospective survey included 50 patients who had undergone EVT and were followed for 1 month or longer (median follow-up 56 months). RESULTS Common preoperative symptoms were chemosis (78%), extra-ocular motor palsy (72%), exophthalmos (66%), and tinnitus (26%). CS-dAVF were addressed by transvenous embolization (tVE, n = 48), tVE only was used in 43 instances and tVE plus transarterial embolization (tAE) in five. Two patients underwent tAE only. Procedure-related morbidity (brainstem infarction) was recorded in one patient (2%) and transient symptom exacerbation (paradoxical worsening) in 12 patients (24%). Postoperative digital subtraction angiography showed no major retrograde shunt or cortical venous reflux in any of the 50 patients. Anterograde or minor retrograde residual shunt was observed in 17 patients (34%); three of these underwent additional tVE and four had Gamma Knife surgery. The shunt flow disappeared in all 17 patients 12.6 ± 13.4 (mean ± SD) months after initial EVT. At the latest follow-up, 65.7 ± 52.6 months after the initial operation, no shunt flow was observed in any of the 50 patients. None had remaining or newly developed chemosis or tinnitus on follow-up. The rate of persistent cavernous sinus symptoms at the latest follow-up was higher in patients with than without post-procedural paradoxical worsening (5/12, 41.7% vs. 2/38, 5.3%, p = 0.0059 by Fisher's exact test). CONCLUSIONS Long-term follow-up showed that EVT, especially tVE, is an efficient and safe treatment for CS-dAVF. It resulted in the eventual disappearance of shunt flow. Residual shunt without major retrograde flow or cortical venous reflux can be monitored without additional treatment.
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36
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Buell TJ, Raper DM, Ding D, Chen CJ, Liu KC. Development of an intracranial dural arteriovenous fistula after venous sinus stenting for idiopathic intracranial hypertension. BMJ Case Rep 2017; 2017:bcr-2017-013282. [PMID: 28951386 DOI: 10.1136/bcr-2017-013282] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We report a case in which an intracranial dural arteriovenous fistula (DAVF) developed after endovascular treatment of a patient with idiopathic intracranial hypertension with venous sinus stenting (VSS). The pathogenesis may involve hemodynamic alterations secondary to increased poststenting venous sinus pressure, which may cause new arterial ingrowth into the fistulous sinus wall without capillary interposition. Despite administration of dual antiplatelet therapy, there may also be subclinical cortical vein thrombosis that contributed to DAVF formation. In addition to the aforementioned mechanisms, increased inflammation induced by VSS may upregulate vascular endothelial growth factor and platelet-derived growth factor expression and also promote DAVF pathogenesis. Since VSS has been used to obliterate DAVFs, DAVF formation after VSS may seem counterintuitive. Previous stents have generally been closed cell, stainless steel designs used to maximize radial compression of the fistulous sinus wall. In contrast, our patient's stent was an open cell, self-expandable nitinol design (Protégé Everflex). Neurointerventionalists should be aware of this potential, although rare complication of DAVF formation after VSS.
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Affiliation(s)
- Thomas J Buell
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA
| | - Daniel M Raper
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA
| | - Dale Ding
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA
| | - Ching-Jen Chen
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA
| | - Kenneth C Liu
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA
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Wang GC, Chen KP, Chiu TL, Su CF. Treating intracranial dural arteriovenous fistulas with gamma knife radiosurgery: A single-center experience. Tzu Chi Med J 2017; 29:18-23. [PMID: 28757759 PMCID: PMC5509183 DOI: 10.4103/tcmj.tcmj_4_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective: We evaluated the effectiveness and safety of gamma knife radiosurgery (GKRS) for the treatment of intracranial dural arteriovenous fistulas (dural AVFs) over the past 10 years. Materials and Methods: The records of 21 patients diagnosed with dural AVFs between 2004 and 2014 and treated with GKRS were reviewed retrospectively. Complete obliteration (CO) was defined as total symptom relief plus confirmation through magnetic resonance imaging or conventional angiography. Results: The median follow-up was 70.5 months (range 3–136 months). Five patients underwent embolization (2 after GKRS). One patient underwent GKRS twice. The CO rate was 47%, and partial to CO rate was 88%. The complete symptom resolution rate was 77%, and all patients achieved partial to complete symptom resolution. The CO rates for Borden Type I and Type II/III dural AVFs were 66.7% and 25% (P = 0.153), respectively, and complete symptom-free rates were 76.9% and 75.0% (P = 1.000%), respectively. The median duration between initial GKRS and complete symptom resolution was 14.3 months. The median treatment to image-free durations for Borden Type I and Type II/III dural AVFs were 25.9 and 60.4 months (P = 0.028), respectively, and treatment to symptom-free durations were 10.6 and 36.7 months (P = 0.103), respectively. One patient had a recurrent hemorrhage. Two patients experienced brain edema after stereotactic radiosurgery and one patient experienced cystic formation after GKRS. The morbidity rate was 19% (four patients) and there was no mortality. Conclusion: Treatment with GKRS for dural AVFs offers a favorable rate of obliteration. Patients with dural AVFs that are refractory or not amenable to endovascular or surgical therapy may be safely and effectively treated using GKRS.
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Affiliation(s)
- Guan-Chyuan Wang
- Department of Neurosurgery, Neuro-Medical Scientific Center, Buddhist Tzu Chi General Hospital, Hualien, Taiwan.,Department of Surgery, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Kuan-Pin Chen
- Department of Neurosurgery, Neuro-Medical Scientific Center, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Tsung-Lang Chiu
- Department of Neurosurgery, Neuro-Medical Scientific Center, Buddhist Tzu Chi General Hospital, Hualien, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Chain-Fa Su
- Department of Neurosurgery, Neuro-Medical Scientific Center, Buddhist Tzu Chi General Hospital, Hualien, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
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38
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Lee CC, Chen CJ, Chen SC, Yang HC, Lin CJ, Wu CC, Chung WY, Guo WY, Hung-Chi Pan D, Shiau CY, Wu HM. Gamma Knife surgery for clival epidural-osseous dural arteriovenous fistulas. J Neurosurg 2017. [PMID: 28621628 DOI: 10.3171/2017.1.jns161346] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Clival epidural-osseous dural arteriovenous fistula (DAVF) is often associated with a large nidus, multiple arterial feeders, and complex venous drainage. In this study the authors report the outcomes of clival epidural-osseous DAVFs treated using Gamma Knife surgery (GKS). METHODS Thirteen patients with 13 clival epidural-osseous DAVFs were treated with GKS at the authors' institution between 1993 and 2015. Patient age at the time of GKS ranged from 38 to 76 years (median 55 years). Eight DAVFs were classified as Cognard Type I, 4 as Type IIa, and 1 as Type IIa+b. The median treatment volume was 17.6 cm3 (range 6.2-40.3 cm3). The median prescribed margin dose was 16.5 Gy (range 15-18 Gy). Clinical and radiological follow-ups were performed at 6-month intervals. Patient outcomes after GKS were categorized as 1) complete improvement, 2) partial improvement, 3) stationary, and 4) progression. RESULTS All 13 patients demonstrated symptomatic improvement, and on catheter angiography 12 of the 13 patients had complete obliteration and 1 patient had partial obliteration. The median follow-up period was 26 months (range 14-186 months). The median latency period from GKS to obliteration was 21 months (range 8-186 months). There was no intracranial hemorrhage during the follow-up period, and no deaths occurred. Two adverse events were observed following treatment, and 2 patients required repeat GKS treatment with eventual complete obliteration. CONCLUSIONS Gamma Knife surgery offers a safe and effective primary or adjuvant treatment modality for complex clival epidural-osseous DAVFs. All patients in this case series demonstrated symptomatic improvement, and almost all patients attained complete obliteration.
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Affiliation(s)
- Cheng-Chia Lee
- Departments of1Neurosurgery.,4School of Medicine, National Yang-Ming University
| | - Ching-Jen Chen
- 6Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | | | - Huai-Che Yang
- Departments of1Neurosurgery.,4School of Medicine, National Yang-Ming University
| | - Chung Jung Lin
- 2Radiology, and.,4School of Medicine, National Yang-Ming University
| | - Chih-Chun Wu
- 2Radiology, and.,4School of Medicine, National Yang-Ming University
| | - Wen-Yuh Chung
- Departments of1Neurosurgery.,4School of Medicine, National Yang-Ming University
| | - Wan-Yuo Guo
- 2Radiology, and.,4School of Medicine, National Yang-Ming University
| | - David Hung-Chi Pan
- Departments of1Neurosurgery.,5Taipei Medical University-Shuang Ho Hospital, Taipei, Taiwan; and
| | - Cheng-Ying Shiau
- 3Radiation Oncology, Taipei Veterans General Hospital.,4School of Medicine, National Yang-Ming University
| | - Hsiu-Mei Wu
- 2Radiology, and.,4School of Medicine, National Yang-Ming University
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Kannath SK, Rajan JE, Sarma SP. Anatomical localization of the cavernous sinus dural fistula by 3D rotational angiography with emphasis on clinical and therapeutic implications. J Neuroradiol 2017; 44:326-332. [PMID: 28602497 DOI: 10.1016/j.neurad.2017.05.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 04/24/2017] [Accepted: 05/03/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND PURPOSE Carotid cavernous sinus dural arteriovenous fistulas (CSDAVFs) are presumed to be located within the walls of the cavernous sinus, however the exact fistulous site has not yet been studied by angiographic or anatomical methods. The present study aimed to localize CSDAVFs with the help of 3D rotational angiography (RA) and correlated the observations with clinical and angiographic findings. MATERIALS AND METHODS The CSDAVFs were categorized as dural, extradural or osseous based on the site of convergence of feeders into the venous sac. Extradural CSDAVFs were further subcategorized into posteromedial, posterolateral and anterior subtypes, depending on proximity to a possible venous plexus. This classification was correlated with various clinical presentations and angiographic subtypes. RESULTS Thirty-seven patients were included in the final analysis. The sac was identified in all the patients and the mean sac size of the fistula was small (<4mm). Dural type was associated with exclusive cortical venous drainage. Extradural anterior CSDAVF showed tendency towards younger age predilection. Extradural posterolateral CSDAVF was more often associated with initial oculomotor nerve palsy and this observation was statistically significant. Discordancy between the location of the fistula and the side of clinical affection was observed in midline fistulas such as osseous CSDAVF and posteromedial type of extradural CSDAVF. CONCLUSIONS CSDAVF is a heterogeneous vascular disorder involving the sphenoclival bone, extradural space and dura, homologous to the epidural-dural shunts of vertebra with a common clinical presentation of orbital manifestations. Preoperative localization of the fistula could explain enigmatic observations and potentially simplify its interventional management.
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Affiliation(s)
- Santhosh Kumar Kannath
- Neurointervention Center, Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute of Medical Sciences and Technology, pin no. 695011, Trivandrum, Kerala, India.
| | - Jayadevan Enakshy Rajan
- Neurointervention Center, Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute of Medical Sciences and Technology, pin no. 695011, Trivandrum, Kerala, India.
| | - Sankara P Sarma
- Achutha Menon Center for Health Science Studies, Sree Chitra Tirunal Institute of Medical Sciences and Technology, pin no. 695011, Trivandrum, Kerala, India.
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Park SH, Park KS, Kang DH, Hwang JH, Hwang SK. Stereotactic radiosurgery for intracranial dural arteriovenous fistulas: its clinical and angiographic perspectives. Acta Neurochir (Wien) 2017; 159:1093-1103. [PMID: 28401318 DOI: 10.1007/s00701-017-3177-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 03/30/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND To assess the efficacy of stereotactic radiosurgery (SRS) for intracranial dural arteriovenous fistulas (DAVFs), the authors retrospectively reviewed our 7-year experience. We evaluated the obliteration rate, improvement in clinical symptoms, and complications. METHODS Thirty patients with DAVF underwent SRS using a Gamma Knife between 2009 and 2015. Twenty-three patients were treated with SRS alone, and seven patients underwent SRS for residual or recurrent DAVFs after embolization or surgery. Chemosis, diplopia, and pulsating tinnitus were the most common symptoms. Median target volume was 2.9 cm3 (range, 0.8-13.6 cm3), and median radiation dose to the target was 17 Gy (range, 12-20 Gy). Median follow-up period was 33 months (range, 6-82 months). RESULTS At the last neuroimaging follow-up, DAVFs were totally obliterated in 23 patients (77%) and subtotally in 7 (23%). At the last clinical follow-up, 21 patients (70%) showed complete recovery, and 9 (30%) showed incomplete recovery in symptoms or signs. None experienced worsening symptoms or signs. Asymptomatic perilesional edema after SRS occurred in one patient (3%). Total obliteration rates after SRS were 43% at 1 year, 79% at 2 years, and 95% at 5 years. Improvement rates of neurological function after SRS were 12% at 1 month, 52% at 2 months, 72% at 3 months, and 96% at 6 months. A multivariate analysis revealed that Borden type 1 (p = 0.019, hazard ratio, 3.254, 95% confidence interval, 1.216-8.707) was significantly associated with symptom improvement. CONCLUSIONS SRS for intracranial DAVFs provided a high obliteration rate and a relatively low risk of radiation-induced complications. In selected benign cases without cortical venous drainage, SRS is a safe and effective treatment for symptom relief and fistula obliteration, even though the time course of improvement is longer than those of embolization and surgery.
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Affiliation(s)
- Seong-Hyun Park
- Department of Neurosurgery, Kyungpook National University Hospital, 130 Dongduk-ro, Jung-gu, Daegu, 700-721, South Korea.
| | - Ki-Su Park
- Department of Neurosurgery, Kyungpook National University Hospital, 130 Dongduk-ro, Jung-gu, Daegu, 700-721, South Korea
| | - Dong-Hun Kang
- Department of Neurosurgery, Kyungpook National University Hospital, 130 Dongduk-ro, Jung-gu, Daegu, 700-721, South Korea
- Department of Radiology, Kyungpook National University Hospital, Daegu, South Korea
| | - Jeong-Hyun Hwang
- Department of Neurosurgery, Kyungpook National University Hospital, 130 Dongduk-ro, Jung-gu, Daegu, 700-721, South Korea
| | - Sung-Kyoo Hwang
- Department of Neurosurgery, Kyungpook National University Hospital, 130 Dongduk-ro, Jung-gu, Daegu, 700-721, South Korea
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Park SH, Park KS, Kang DH, Hwang JH, Hwang SK. Stereotactic Radiosurgery for Dural Carotid Cavernous Sinus Fistulas. World Neurosurg 2017; 106:836-843. [PMID: 28465265 DOI: 10.1016/j.wneu.2017.04.143] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 04/20/2017] [Accepted: 04/21/2017] [Indexed: 11/15/2022]
Abstract
OBJECTIVE We reviewed our 7-year experience to assess the efficacy of stereotactic radiosurgery (SRS) for dural carotid cavernous fistulas (DCCFs). We analyzed the clinical outcome, complications, and angiographic results. METHODS We performed a retrospective analysis of 18 consecutive patients with DCCFs treated by SRS alone using Gamma Knife between 2009 and 2015. Median target volume was 2.6 cm3 (range, 0.6-11.6 cm3), and median radiation dose to the target was 17 Gy (range, 14-19 Gy). Median follow-up period was 30 months (range, 6-65 months). RESULTS Fifteen patients (83%) achieved total obliteration of the DCCF, and a subtotal obliteration of the DCCF was achieved in 3 patients (17%). Total obliteration rates after SRS were 53% at 1 year and 90% at 2 years. Twelve patients (67%) showed complete recovery from symptoms or signs, and 6 patients (33%) showed incomplete recovery. Improvement rates of neurologic function after SRS were 56% at 1 month, 72% at 3 months, and 94% at 6 months. None of the patients experienced radiation-related complications. A univariate analysis revealed that absence of hypertension (P = 0.025), seizure (P = 0.025), and cortical venous drainage (P = 0.013) were significantly associated with symptoms improvement. CONCLUSIONS SRS for DCCFs offered a high obliteration rate with low risk of radiation-induced complications. In patients with benign DCCFs that are not amenable to embolization or microsurgery, SRS is a safe and effective treatment for complete obliteration of the arteriovenous shunt and for improving quality of life.
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Affiliation(s)
- Seong-Hyun Park
- Department of Neurosurgery, Kyungpook National University Hospital, Daegu, South Korea.
| | - Ki-Su Park
- Department of Neurosurgery, Kyungpook National University Hospital, Daegu, South Korea
| | - Dong-Hun Kang
- Department of Neurosurgery, Kyungpook National University Hospital, Daegu, South Korea; Department of Radiation, Kyungpook National University Hospital, Daegu, South Korea
| | - Jeong-Hyun Hwang
- Department of Neurosurgery, Kyungpook National University Hospital, Daegu, South Korea
| | - Sung-Kyoo Hwang
- Department of Neurosurgery, Kyungpook National University Hospital, Daegu, South Korea
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National Perspectives on the Training of Neurosurgery Residents in Stereotactic Radiosurgery. Can J Neurol Sci 2017; 44:51-58. [PMID: 28004631 DOI: 10.1017/cjn.2016.314] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Despite the critical role played by neurosurgeons in performing radiosurgery, neurosurgery residents in Canada have limited exposure to radiosurgery during their training. A survey of neurosurgery residents and faculty along with radiation oncology faculty was conducted to analyze perspectives regarding incorporating formal radiosurgery training into the neurosurgery residency curriculum Methods: An online survey platform was employed. Descriptive statistics were used to summarize center and respondent characteristics. Categorical variables were compared using odds ratios and corresponding 95% confidence intervals. The chi-squared test was utilized to assess statistical significance. A value of p<0.05 was considered significant Results: The response rate was 31% (119/381); 87% (102/119) of respondents were from the neurosurgical specialty and 13% (17/119) from radiation oncology. Some 46% of residents (18/40) were "very uncomfortable" with radiosurgery techniques, and 57% of faculty (42/73) believed that dedicated radiosurgery training would be beneficial though impractical. No respondents felt that "no training" would be beneficial. A total of 46% of residents (19/41) felt that this training would be beneficial and that time should be taken away from other rotations, if needed, while 58% of faculty (42/73) and 75% (28/41) of residents believed that either 1 or 1-3 months of time dedicated to training in radiosurgery would suffice Conclusions: Canadian neurosurgeons are actively involved in radiosurgery. Despite residents anticipating a greater role for radiosurgery in their future, they are uncomfortable with the practice. With the indications for radiosurgery expanding, this training gap can have serious adverse consequences for patients. Considerations regarding the incorporation and optimal duration of dedicated radiosurgery training into the Canadian neurosurgery residency curriculum are necessary.
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Ding D, Starke RM, Moriarty M, Brew S. Pericardium Covered Stent Graft for Endovascular Treatment of a Traumatic Carotid-cavernous Fistula. J Neurosci Rural Pract 2017; 7:S137-S138. [PMID: 28163534 PMCID: PMC5244053 DOI: 10.4103/0976-3147.196438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Dale Ding
- Department of Neurosurgery, University of Virginia, Charlottesville, VA 22908, USA; Department of Neurosurgery, Auckland City Hospital, Auckland 1142, New Zealand
| | - Robert M Starke
- Department of Neurological Surgery, University of Miami, Miami, FL 33136, USA
| | - Maurice Moriarty
- Department of Radiology, Auckland City Hospital, Auckland 1142, New Zealand
| | - Stefan Brew
- Department of Radiology, Auckland City Hospital, Auckland 1142, New Zealand
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44
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Ding D, McGuinness B, Brew S. Embolization of a Complex Posterior Fossa Dural Arteriovenous Fistula with Precipitating Hydrophobic Injectable Liquid. J Neurosci Rural Pract 2017; 7:S135-S137. [PMID: 28163533 PMCID: PMC5244052 DOI: 10.4103/0976-3147.196437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Dale Ding
- Department of Neurosurgery, University of Virginia, Charlottesville, VA 22908, USA; Department of Neurosurgery, Auckland City Hospital, Auckland 1142, New Zealand
| | - Ben McGuinness
- Department of Radiology, Auckland City Hospital, Auckland 1142, New Zealand
| | - Stefan Brew
- Department of Radiology, Auckland City Hospital, Auckland 1142, New Zealand
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Chen CJ, Mastorakos P, Caruso JP, Ding D, Schmitt PJ, Buell TJ, Raper DM, Evans A, Newman SA, Jensen ME. Transorbital Approach for Endovascular Occlusion of Carotid-Cavernous Fistulas: Technical Note and Review of the Literature. Cureus 2017; 9:e976. [PMID: 28191380 PMCID: PMC5298197 DOI: 10.7759/cureus.976] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Carotid-cavernous fistulas (CCFs) pose an anatomically and physiologically challenging problem for clinicians. The most common method of treatment for these lesions is transvenous endovascular embolization via the inferior petrosal sinus or the facial vein. When transvenous access is not possible, an alternate approach must be devised. We describe a case example with bilateral Barrow Type B CCFs, which were inaccessible using the traditional transvenous approach. Hence, a direct transorbital approach, performed under fluoroscopic guidance, was employed to successfully obliterate the CCF. At five months follow-up, the patient was recovering without complications. This case delineates the technical aspects of transorbital CCF embolization and demonstrates that this approach is a viable alternative to conventional transvenous methods for appropriately selected CCF cases. We supplement our case example and technical note with a literature review of this approach.
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Affiliation(s)
- Ching-Jen Chen
- Department of Neurological Surgery, University Of Virginia
| | | | - James P Caruso
- Department of Neurological Surgery, University Of Virginia
| | - Dale Ding
- Department of Neurological Surgery, University Of Virginia
| | - Paul J Schmitt
- Department of Neurological Surgery, University Of Virginia
| | - Thomas J Buell
- Department of Neurological Surgery, University Of Virginia
| | - Daniel M Raper
- Department of Neurological Sugery, University Of Virginia
| | - Avery Evans
- Department of Interventional Neuroradiology, University Of Virginia
| | | | - Mary E Jensen
- Department of Interventional Neuroradiology, University Of Virginia
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46
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Grady C, Gesteira Benjamin C, Kondziolka D. Radiosurgery for dural arteriovenous malformations. HANDBOOK OF CLINICAL NEUROLOGY 2017; 143:125-131. [PMID: 28552134 DOI: 10.1016/b978-0-444-63640-9.00012-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Intracranial dural arteriovenous malformations (DAVFs) are relatively uncommon vascular lesions characterized by the direct connection of dural arteries into dural venous sinuses or leptomeningeal veins. Strategies for the treatment of these complex lesions have evolved significantly over the past three decades, and include open surgical disconnection, endovascular embolization, stereotactic radiosurgery (SRS), or a combination of these approaches. Radiosurgical intervention is unique in offering significant benefits to patients while exposing them to few of the risks associated with more invasive interventions. In this chapter we provide an overview of DAVFs and discuss the features of these lesions that affect management. We focus, in particular, on radiosurgical management of these lesions, describing present treatment paradigms, the procedure for the treatment of DAVFs with SRS, and expected clinical outcomes using SRS.
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Affiliation(s)
- Conor Grady
- Department of Neurosurgery, NYU Langone Medical Center, New York, NY, USA
| | | | - Douglas Kondziolka
- Department of Neurosurgery, NYU Langone Medical Center, New York, NY, USA; Center for Advanced Radiosurgery, NYU Langone Medical Center, New York, NY, USA.
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Ding D, Starke RM, Sheehan JP. Radiosurgery for the management of cerebral arteriovenous malformations. HANDBOOK OF CLINICAL NEUROLOGY 2017; 143:69-83. [PMID: 28552160 DOI: 10.1016/b978-0-444-63640-9.00007-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Cerebral arteriovenous malformations (AVMs) are rare, unstable vascular lesions which spontaneously rupture at a rate of approximately 2-4% annually. Stereotactic radiosurgery is a minimally invasive treatment for AVMs, with a favorable risk-to-benefit profile in most patients, with respect to obliteration, hemorrhage, and seizure control. Radiosurgery is ideally suited for small to medium-sized AVMs (diameter <3cm or volume <12cm3) located in deep or eloquent brain regions. Obliteration is ultimately achieved in 70-80% of cases and is directly associated with nidus volume and radiosurgical margin dose. Adverse radiation effects, which appear as T2-weighted hyperintensities on magnetic resonance imaging, develop in 30-40% of patients after AVM radiosurgery, are symptomatic in 10%, and fail to clinically resolve in 2-3%. The risk of AVM hemorrhage may be reduced by radiosurgery, but the hemorrhage risk persists during the latency period between treatment and obliteration. Delayed postradiosurgery cyst formation occurs in 2% of cases and may require surgical treatment. Radiosurgery abolishes or ameliorates seizure activity in the majority of patients with AVM-associated epilepsy and induces de novo seizures in 1-2% of those without preoperative seizures. Strategies for the treatment of large-volume AVMs include neoadjuvant embolization and either dose- or volume-staged radiosurgery.
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Affiliation(s)
- Dale Ding
- Department of Neurosurgery, University of Virginia, Charlottesville, VA, USA
| | - Robert M Starke
- Department of Neurosurgery, University of Virginia, Charlottesville, VA, USA
| | - Jason P Sheehan
- Department of Neurosurgery, University of Virginia, Charlottesville, VA, USA.
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Guo WY, Lee CCJ, Lin CJ, Yang HC, Wu HM, Wu CC, Chung WY, Liu KD. Quantifying the Cerebral Hemodynamics of Dural Arteriovenous Fistula in Transverse Sigmoid Sinus Complicated by Sinus Stenosis: A Retrospective Cohort Study. AJNR Am J Neuroradiol 2017; 38:132-138. [PMID: 27765737 DOI: 10.3174/ajnr.a4960] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 08/18/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Sinus stenosis occasionally occurs in dural arteriovenous fistulas. Sinus stenosis impedes venous outflow and aggravates intracranial hypertension by reversing cortical venous drainage. This study aimed to analyze the likelihood of sinus stenosis and its impact on cerebral hemodynamics of various types of dural arteriovenous fistulas. MATERIALS AND METHODS Forty-three cases of dural arteriovenous fistula in the transverse-sigmoid sinus were reviewed and divided into 3 groups: Cognard type I, type IIa, and types with cortical venous drainage. Sinus stenosis and the double peak sign (occurrence of 2 peaks in the time-density curve of the ipsilateral drainage of the internal jugular vein) in dural arteriovenous fistula were evaluated. "TTP" was defined as the time at which a selected angiographic point reached maximum concentration. TTP of the vein of Labbé, TTP of the ipsilateral normal transverse sinus, trans-fistula time, and trans-stenotic time were compared across the 3 groups. RESULTS Thirty-six percent of type I, 100% of type IIa, and 84% of types with cortical venous drainage had sinus stenosis. All sinus stenosis cases demonstrated loss of the double peak sign that occurs in dural arteriovenous fistula. Trans-fistula time (2.09 seconds) and trans-stenotic time (0.67 seconds) in types with cortical venous drainage were the most prolonged, followed by those in type IIa and type I. TTP of the vein of Labbé was significantly shorter in types with cortical venous drainage. Six patients with types with cortical venous drainage underwent venoplasty and stent placement, and 4 were downgraded to type IIa. CONCLUSIONS Sinus stenosis indicated dysfunction of venous drainage and is more often encountered in dural arteriovenous fistula with more aggressive types. Venoplasty ameliorates cortical venous drainage in dural arteriovenous fistulas and serves as a bridge treatment to stereotactic radiosurgery in most cases.
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Affiliation(s)
- W-Y Guo
- From the Department of Radiology (W.-Y.G., C.-J.L., H.-M.W., C.-C.W.)
- School of Medicine (W.-Y.G., C.-C.J.L., C.-J.L., H.-C.Y., H.-M.W., C.-C.W., W.-Y.C., K.-D.L.), National Yang-Ming University, Taipei, Taiwan
| | - C-C J Lee
- Department of Neurosurgery (C.-C.J.L., H.-C.Y., W.-Y.C., K.-D.L.), Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine (W.-Y.G., C.-C.J.L., C.-J.L., H.-C.Y., H.-M.W., C.-C.W., W.-Y.C., K.-D.L.), National Yang-Ming University, Taipei, Taiwan
| | - C-J Lin
- From the Department of Radiology (W.-Y.G., C.-J.L., H.-M.W., C.-C.W.)
- School of Medicine (W.-Y.G., C.-C.J.L., C.-J.L., H.-C.Y., H.-M.W., C.-C.W., W.-Y.C., K.-D.L.), National Yang-Ming University, Taipei, Taiwan
| | - H-C Yang
- Department of Neurosurgery (C.-C.J.L., H.-C.Y., W.-Y.C., K.-D.L.), Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine (W.-Y.G., C.-C.J.L., C.-J.L., H.-C.Y., H.-M.W., C.-C.W., W.-Y.C., K.-D.L.), National Yang-Ming University, Taipei, Taiwan
| | - H-M Wu
- From the Department of Radiology (W.-Y.G., C.-J.L., H.-M.W., C.-C.W.)
- School of Medicine (W.-Y.G., C.-C.J.L., C.-J.L., H.-C.Y., H.-M.W., C.-C.W., W.-Y.C., K.-D.L.), National Yang-Ming University, Taipei, Taiwan
| | - C-C Wu
- From the Department of Radiology (W.-Y.G., C.-J.L., H.-M.W., C.-C.W.)
- School of Medicine (W.-Y.G., C.-C.J.L., C.-J.L., H.-C.Y., H.-M.W., C.-C.W., W.-Y.C., K.-D.L.), National Yang-Ming University, Taipei, Taiwan
| | - W-Y Chung
- Department of Neurosurgery (C.-C.J.L., H.-C.Y., W.-Y.C., K.-D.L.), Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine (W.-Y.G., C.-C.J.L., C.-J.L., H.-C.Y., H.-M.W., C.-C.W., W.-Y.C., K.-D.L.), National Yang-Ming University, Taipei, Taiwan
| | - K-D Liu
- Department of Neurosurgery (C.-C.J.L., H.-C.Y., W.-Y.C., K.-D.L.), Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine (W.-Y.G., C.-C.J.L., C.-J.L., H.-C.Y., H.-M.W., C.-C.W., W.-Y.C., K.-D.L.), National Yang-Ming University, Taipei, Taiwan
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Dmytriw AA, Schwartz ML, Cusimano MD, Mendes Pereira V, Krings T, Tymianski M, Radovanovic I, Agid R. Gamma Knife radiosurgery for the treatment of intracranial dural arteriovenous fistulas. Interv Neuroradiol 2016; 23:211-220. [PMID: 28156167 DOI: 10.1177/1591019916683689] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Intracranial dural arteriovenous fistulae (DAVF) may present a treatment challenge. Endovascular embolization is in most cases the first line of treatment but does not always achieve cure. Gamma Knife (GK) radiosurgery represents an alternative treatment option, and the purpose of this study was to further evaluate its utility. Methods We reviewed all cases of DAVF treated between 2009 and 2016 at our institution with GK radiosurgery independently, or following failed/refused endovascular or surgical management. Patients' clinical files, radiological images, catheter angiograms, and surgical DAVF disconnection reports were retrospectively reviewed. Results Sixteen DAVF (14 patients) treated by GK radiosurgery were identified. Eleven fistulae were aggressive and five were benign. Marginal doses ranged from 15 to 25 Gy. Target volumes ranged from 0.04 to 4.47 cm3. In all symptomatic patients, GK treatment resulted in symptom palliation. In 13/15 lesions, cure of symptoms (86.0%) was reported. One lesion was asymptomatic. Angiographic cure was achieved in eight cases (50%), small residual DAVF occurred in four, and four were unchanged. One patient developed headache that resolved at one year. No hemorrhage occurred during the follow-up period. There was no significant association between Borden type and cure rate. Prior failed endovascular treatment and small target volume were associated with lower rates of cure. Conclusions Stereotactic radiosurgery is viable treatment for DAVF. It is very effective in palliating symptoms as a de novo approach or adjunctive to endovascular therapy. In our experience it is only somewhat effective in achieving complete angiographic cure.
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Affiliation(s)
- Adam A Dmytriw
- 1 Department of Medical Imaging, Division of Neuroradiology, Toronto Western Hospital, University Health Network & University of Toronto, Canada
| | - Michael L Schwartz
- 2 Department of Neurosurgery, Sunnybrook Health Sciences Centre and Gamma Knife Centre, Toronto Western Hospital, Canada
| | | | - Vitor Mendes Pereira
- 1 Department of Medical Imaging, Division of Neuroradiology, Toronto Western Hospital, University Health Network & University of Toronto, Canada
| | - Timo Krings
- 1 Department of Medical Imaging, Division of Neuroradiology, Toronto Western Hospital, University Health Network & University of Toronto, Canada
| | - Michael Tymianski
- 4 Department of Neurosurgery, Toronto Western Hospital, University Health Network, Canada
| | - Ivan Radovanovic
- 4 Department of Neurosurgery, Toronto Western Hospital, University Health Network, Canada
| | - Ronit Agid
- 1 Department of Medical Imaging, Division of Neuroradiology, Toronto Western Hospital, University Health Network & University of Toronto, Canada
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50
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Ding D, Starke RM, Liu KC, Crowley RW. Cortical plasticity in patients with cerebral arteriovenous malformations. J Clin Neurosci 2016; 22:1857-61. [PMID: 26256067 DOI: 10.1016/j.jocn.2015.06.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 06/20/2015] [Indexed: 10/22/2022]
Abstract
The aim of this review is to ascertain the evidence for cortical plasticity in arteriovenous malformation (AVM) patients. Chronic hypoperfusion due to vascular steal from cerebral AVM can result in a translocation of eloquent neurological functions to other brain areas, a phenomenon known as cortical plasticity. We performed a systematic literature review of the studies that have evaluated cortical plasticity in AVM patients. A total of 22 studies from 1996 to 2014 were included for the analyses. The evaluation of cortical plasticity was performed prior to AVM intervention in 109 patients, and during or after AVM intervention in 18. The most commonly assessed neurological functions were motor in 85% and language in 11% of the former cohort, and motor in 78% and language, cognition, and memory each in 39% of the latter cohort. Functional MRI was the most frequently used method for evaluating cortical plasticity, and was performed in 63% of the former and 56% of the latter cohort. In conclusion, cortical plasticity appears to be influenced by both AVM pathogenesis and intervention. Given the limited evidence that is currently available for cortical plasticity in AVM patients, further studies are warranted to determine its incidence and impact on long term clinical outcomes.
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Affiliation(s)
- Dale Ding
- Department of Neurosurgery, University of Virginia, Post Office Box 800212, Charlottesville, VA 22908, USA.
| | - Robert M Starke
- Department of Neurosurgery, University of Virginia, Post Office Box 800212, Charlottesville, VA 22908, USA
| | - Kenneth C Liu
- Department of Neurosurgery, University of Virginia, Post Office Box 800212, Charlottesville, VA 22908, USA; Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA, USA
| | - R Webster Crowley
- Department of Neurosurgery, University of Virginia, Post Office Box 800212, Charlottesville, VA 22908, USA; Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA, USA
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