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Gamma Knife surgery for low-flow cavernous sinus dural arteriovenous fistulas.

Authors
 Hyun Ho Jung  ;  Jong Hee Chang  ;  Kum Whang  ;  Jin Soo Pyen  ;  Jin Woo Chang  ;  Yong Gou Park 
Citation
 JOURNAL OF NEUROSURGERY, Vol.113(suppl) : 21-27, 2010 
Journal Title
JOURNAL OF NEUROSURGERY
ISSN
 0022-3085 
Issue Date
2010
MeSH
Aged ; Cavernous Sinus/diagnostic imaging ; Cavernous Sinus/surgery* ; Central Nervous System Vascular Malformations/diagnostic imaging ; Central Nervous System Vascular Malformations/surgery* ; Female ; Humans ; Male ; Middle Aged ; Radiography ; Radiosurgery/instrumentation* ; Treatment Outcome
Keywords
Gamma Knife ; radiosurgery ; cavernous sinus ; dural arteriovenous fistula
Abstract
OBJECT: The purpose of this study was to assess the efficacy of Gamma Knife surgery (GKS) for treating cavernous sinus dural arteriovenous fistulas (CSDAVFs).

METHODS: Of the 4123 GKSs performed between May 1992 and March 2009, 890 procedures were undertaken to treat vascular lesions. In 24 cases, the vascular lesion that was treated was a dural arteriovenous fistula, and in 6 of these cases, the lesion involved the cavernous sinus. One of these 6 cases was lost to follow-up, leaving the other 5 cases (4 women and 1 man) to comprise the subjects of this study. All 5 patients had more than 1 ocular symptom, such as ptosis, chemosis, proptosis, and extraocular movement palsy. In all patients, CSDAVF was confirmed by conventional angiography. Three patients were treated by GKS alone and 2 patients were treated by GKS combined with transarterial embolization. The median follow-up period after GKS in these 5 cases was 30 months (range 9-59 months).

RESULTS: All patients experienced clinical improvement, and their improvement in ocular symptoms was noticed at a mean of 17.6 weeks after GKS (range 4-24 weeks). Two patients received embolization prior to GKS but did not display improvement in ocular symptoms. An average of 20 weeks (range 12-24 weeks) was needed for complete improvement in clinical symptoms. There were no treatment-related complications during the follow-up period.

CONCLUSIONS: Gamma Knife surgery should be considered as a primary, combined, or additional treatment option for CSDAVF in selected cases, such as when the lesion is a low-flow shunt without cortical venous drainage. For those selected cases, GKS alone may suffice as the primary treatment method when combined with close monitoring of ocular symptoms and intraocular pressure.
Full Text
http://thejns.org/doi/pdf/10.3171/2010.8.GKS10977
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Neurosurgery (신경외과학교실) > 1. Journal Papers
Yonsei Authors
Park, Yong Gou(박용구)
Chang, Jong Hee(장종희) ORCID logo https://orcid.org/0000-0003-1509-9800
Chang, Jin Woo(장진우) ORCID logo https://orcid.org/0000-0002-2717-0101
Jung, Hyun Ho(정현호)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/102513
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