Document Detail

Stereotactic Radiosurgery with or without Embolization for Intracranial Dural Arteriovenous Fistulas.
MedLine Citation:
PMID:  23258523     Owner:  NLM     Status:  In-Data-Review    
Treatment options for symptomatic dural arteriovenous fistulas (DAVFs) include surgery, embolization and stereotactic radiosurgery (SRS). We reviewed our DAVF experience at the University of Pittsburgh and assessed the role of SRS. We evaluated 40 consecutive patients who underwent Gamma Knife SRS for 44 DAVFs. Twenty-eight patients had upfront SRS before or after embolization performed at our institution, and 12 patients underwent delayed SRS for recurrent or residual DAVFs after initial embolization. The median SRS target volume was 2.0 cm(3), and the median marginal dose was 21.0 Gy. At a median follow-up of 45 months (range, 23-116 months), a total of 28 patients with 32 DAVFs had obliteration. The obliteration rate was 83% for patients who had upfront SRS and embolization. The obliteration rate was lower (67%) for patients managed with SRS alone. The obliteration rate was 71% for patients who had delayed SRS for recurrent or residual DAVFs following prior embolization. In our experience cavernous/carotid fistulas were associated with higher rates of obliteration and symptomatic improvement compared to transverse/sigmoid sinus region fistulas. Our experience suggests that successful DAVF obliteration is possible in most patients with upfront SRS in conjunction with embolization. SRS alone is an effective treatment for selected patients with a small-volume, low-risk DAVF.
Huaiche Yang; Hideyuki Kano; Douglas Kondziolka; Ajay Niranjan; John C Flickinger; Michael B Horowitz; L Dade Lunsford
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Publication Detail:
Type:  Journal Article     Date:  2012-12-11
Journal Detail:
Title:  Progress in neurological surgery     Volume:  27     ISSN:  1662-3924     ISO Abbreviation:  Prog Neurol Surg     Publication Date:  2013  
Date Detail:
Created Date:  2012-12-21     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0076033     Medline TA:  Prog Neurol Surg     Country:  Switzerland    
Other Details:
Languages:  eng     Pagination:  195-204     Citation Subset:  IM    
Copyright Information:
Copyright © 2013 S. Karger AG, Basel.
Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pa., USA.
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