Venous outflow restriction as a predictor of cavernous sinus dural arteriovenous fistula obliteration after Gamma Knife surgery

Chia An Wu, Huai Che Yang, Yong Sin Hu, Hsiu Mei Wu, Chung Jung Lin*, Chao Bao Luo, Wan Yuo Guo, Cheng Chia Lee, Kang Du Liu, Wen Yuh Chung

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

8 Scopus citations

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.

Original languageEnglish
Pages (from-to)132-139
Number of pages8
JournalJournal of Neurosurgery
Volume132
Issue number1
DOIs
StatePublished - 2020

Keywords

  • Cavernous sinus
  • Dural arteriovenous fistula
  • GAMMA Knife surgery
  • Stereotactic radiosurgery
  • Vascular disorders

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