Gamma Knife Radiosurgery: The Gold Standard Treatment for Intracranial Dural Arteriovenous Fistulas without Cortical Venous Drainage

2020 ◽  
Vol 68 (4) ◽  
pp. 815
Author(s):  
Deepak Agrawal ◽  
Hardik Sardana ◽  
Niveditha Manjunath
Keyword(s):  
Gamma Knife ◽  
Gold Standard ◽  
Standard Treatment ◽  
Gamma Knife Radiosurgery ◽  
Venous Drainage ◽  
Arteriovenous Fistulas ◽  
Dural Arteriovenous Fistulas ◽  
Cortical Venous Drainage

scholarly journals Bifrontal approach for clip ligation of bilateral ethmoidal dural arteriovenous fistulas: operative video

2019 ◽  
Vol 46 (Suppl_2) ◽  
pp. V14 ◽  
Author(s):  
Tyler S. Cole ◽  
Sirin Gandhi ◽  
Justin R. Mascitelli ◽  
Douglas Hardesty ◽  
Claudio Cavallo ◽  
...  
Keyword(s):  
Natural History ◽  
Gold Standard ◽  
Dural Arteriovenous Fistula ◽  
Standard Treatment ◽  
Venous Drainage ◽  
Arteriovenous Fistulas ◽  
Sagittal Sinus ◽  
Surgical Clip ◽  
Dural Arteriovenous Fistulas ◽  
Cortical Venous Drainage

Venous interruption through surgical clip ligation is the gold standard treatment for ethmoidal dural arteriovenous fistula (e-dAVF). Their malignant natural history is attributable to the higher predilection for retrograde cortical venous drainage. This video illustrates an e-dAVF in a 70-year-old man with progressive tinnitus and headache. Angiogram revealed bilateral e-dAVFs (Borden III–Cognard III) with one fistula draining into cavernous sinus and another to the sagittal sinus. A bifrontal craniotomy was utilized for venous interruption of both e-dAVFs. Postoperative angiography confirmed curative obliteration with no postoperative anosmia. Bilateral e-dAVFs are rare but can be safely treated simultaneously through a single craniotomy.The video can be found here: https://youtu.be/666edwKHGKc.

scholarly journals Hemorrhage risk of cerebral dural arteriovenous fistulas following Gamma Knife radiosurgery in a multicenter international consortium

2020 ◽  
Vol 132 (4) ◽  
pp. 1209-1217 ◽  
Author(s):  
Robert M. Starke ◽  
David J. McCarthy ◽  
Ching-Jen Chen ◽  
Hideyuki Kano ◽  
Brendan J. McShane ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Gamma Knife ◽  
Gamma Knife Radiosurgery ◽  
Latency Period ◽  
Venous Drainage ◽  
Arteriovenous Fistulas ◽  
Dural Arteriovenous Fistulas ◽  
Before And After

OBJECTIVEThe authors performed a study to evaluate the hemorrhagic rates of cerebral dural arteriovenous fistulas (dAVFs) and the risk factors of hemorrhage following Gamma Knife radiosurgery (GKRS).METHODSData from a cohort of patients undergoing GKRS for cerebral dAVFs were compiled from the International Radiosurgery Research Foundation. The annual posttreatment hemorrhage rate was calculated as the number of hemorrhages divided by the patient-years at risk. Risk factors for dAVF hemorrhage prior to GKRS and during the latency period after radiosurgery were evaluated in a multivariate analysis.RESULTSA total of 147 patients with dAVFs were treated with GKRS. Thirty-six patients (24.5%) presented with hemorrhage. dAVFs that had any cortical venous drainage (CVD) (OR = 3.8, p = 0.003) or convexity or torcula location (OR = 3.3, p = 0.017) were more likely to present with hemorrhage in multivariate analysis. Half of the patients had prior treatment (49.7%). Post-GRKS hemorrhage occurred in 4 patients, with an overall annual risk of 0.84% during the latency period. The annual risks of post-GKRS hemorrhage for Borden type 2–3 dAVFs and Borden type 2–3 hemorrhagic dAVFs were 1.45% and 0.93%, respectively. No hemorrhage occurred after radiological confirmation of obliteration. Independent predictors of hemorrhage following GKRS included nonhemorrhagic neural deficit presentation (HR = 21.6, p = 0.027) and increasing number of past endovascular treatments (HR = 1.81, p = 0.036).CONCLUSIONSPatients have similar rates of hemorrhage before and after radiosurgery until obliteration is achieved. dAVFs that have any CVD or are located in the convexity or torcula were more likely to present with hemorrhage. Patients presenting with nonhemorrhagic neural deficits and a history of endovascular treatments had higher risks of post-GKRS hemorrhage.

scholarly journals Evaluation of stereotactic radiosurgery for cerebral dural arteriovenous fistulas in a multicenter international consortium

2020 ◽  
Vol 132 (1) ◽  
pp. 114-121 ◽  
Author(s):  
Robert M. Starke ◽  
David J. McCarthy ◽  
Ching-Jen Chen ◽  
Hideyuki Kano ◽  
Brendan McShane ◽  
...  
Keyword(s):  
Gamma Knife ◽  
Gamma Knife Radiosurgery ◽  
Multivariate Logistic Regression Analysis ◽  
Favorable Outcome ◽  
Predictors Of Outcome ◽  
Arteriovenous Fistulas ◽  
Dural Arteriovenous Fistulas ◽  
Radiation Induced ◽  
Venous Ectasia ◽  
Grading Scales

OBJECTIVEIn 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.METHODSData 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.RESULTSA 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.CONCLUSIONSGKRS 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.

scholarly journals Arterial spin labeling MR imaging aids to identify cortical venous drainage of dural arteriovenous fistulas

Medicine ◽  
2018 ◽  
Vol 97 (19) ◽  
pp. e0697 ◽  
Author(s):  
Ji Hee Kang ◽  
Tae Jin Yun ◽  
Jong Kook Rhim ◽  
Young Dae Cho ◽  
Dong Hyun Yoo ◽  
...  
Keyword(s):  
Mr Imaging ◽  
Arterial Spin Labeling ◽  
Venous Drainage ◽  
Spin Labeling ◽  
Arteriovenous Fistulas ◽  
Dural Arteriovenous Fistulas ◽  
Cortical Venous Drainage

scholarly journals Reconsidering an important subclass of high-risk dural arteriovenous fistulas for stereotactic radiosurgery

2019 ◽  
Vol 130 (3) ◽  
pp. 972-976 ◽  
Author(s):  
Daniel A. Tonetti ◽  
Bradley A. Gross ◽  
Brian T. Jankowitz ◽  
Hideyuki Kano ◽  
Edward A. Monaco ◽  
...  
Keyword(s):  
High Risk ◽  
Stereotactic Radiosurgery ◽  
Significant Risk ◽  
Venous Drainage ◽  
Significant Risk Factor ◽  
Low Risk ◽  
Arteriovenous Fistulas ◽  
Dural Arteriovenous Fistulas ◽  
Institutional Experience ◽  
Cortical Venous Drainage

OBJECTIVEAggressive 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.METHODSThe 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.RESULTSIn 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.CONCLUSIONSCortical 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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