Treatment Outcomes of Cavernous Sinus Dural Arteriovenous Fistulas: Comparison of Radiosurgery and Endovascular Embolisation


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.


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.


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).


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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Cavernous sinus dural arteriovenous fistula


Complete obliteration


Endovascular treatment


Gamma knife radiosurgery


Venous outflow score


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The authors thank Hsin-Yi Huang (Biostatistics Task Force, Taipei Veterans General Hospital) for statistical assistance, and Wallace Academic Editing for manuscript editing.



This study was funded by Taipei Veterans General Hospital (grant number: V107C-170, 023) and the Ministry of Science and Technology (grant number: MOST-106-2314-B-010-015-MY2, MOST-106-2314B-075-011).

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Guarantors of integrity of entire study, C.B.L, C.J.L, H.C.Y; study concepts/study design or data acquisition or data analysis/interpretation, all authors; manuscript drafting or manuscript revision for important intellectual content, all authors; approval of final version of submitted manuscript, agrees to ensure any questions related to the work are appropriately resolved, all authors; literature research, C.B.L, H.M.W; clinical studies, W.Y.C, C.C.L, K.D.L; statistical analysis, C.J.L; manuscript editing, C.B.L, C.J.L, H.C.Y.

Corresponding author

Correspondence to Chao-Bao Luo.

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H.-C. Yang, C.-J. Lin, C.-B. Luo, C.-C. Lee, H.-M. Wu, W.-Y. Guo, W.-Y. Chung and K.-D. Liu declare that they have no competing interests.

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Yang, H., Lin, C., Luo, C. et al. Treatment Outcomes of Cavernous Sinus Dural Arteriovenous Fistulas: Comparison of Radiosurgery and Endovascular Embolisation. Clin Neuroradiol 30, 321–330 (2020).

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  • Angioarchitecture
  • Arteriovenous fistula
  • Cavernous sinus
  • Endovascular treatment
  • Gamma knife