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Gamma Knife Neurosurgery in the Management of Intracranial Disorders pp 113–119Cite as

Gamma Knife Radiosurgery for the Management of Intracranial Dural Arteriovenous Fistulas

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Part of the book series: Acta Neurochirurgica Supplement ((NEUROCHIRURGICA,volume 116))

Abstract

Background: This report presents our 15-year experience with Gamma Knife radiosurgery (GKS) for the treatment of 321 patients with dural arteriovenous fistulas (DAVFs) in different locations.

Methods: The most common locations of DAVFs were the cavernous sinus (206 cases) and transverse-sigmoid sinus (72 cases), which together accounted for 86.6 % of cases. In all, 54 patients had undergone embolization or surgery prior to radiosurgery, and the other patients underwent GKS as the primary treatment. During GKS, radiation was confined to the involved sinus wall, which was considered the true nidus of the DAVF. Target volume ranged from 0.8 to 52 cm3. Marginal and maximum doses to the nidus ranged from 14 to 25 Gy and from 25 to 36 Gy, respectively.

Results: The mean follow-up time was 28 months (range 2–149 months). In 264 of 321 patients (82 %) available for follow-up study, 173 (66 %) showed complete obliteration of DAVFs with symptomatic resolution, 87 (33 %) had partial obliteration, 2 (0.8 %) had stationary status, 1 (0.4 %) had progression, and 1 (0.4 %) died from a new hemorrhagic episode. Complications were found in only two (0.8 %) patients, one with venous hemorrhage and one with focal brain edema after GKS.

Conclusions: GKS is a safe, effective treatment for DAVFs. It provides a minimally invasive therapeutic option for patients who harbor less-aggressive DAVFs but who suffer from intolerable clinical symptoms. For some aggressive DAVFs with extensive venous hypertension or hemorrhage, multimodal treatment with combined embolization or surgery is necessary.

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Conflict of Interest

The authors declare that they have no conflict of interests.

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Authors and Affiliations

  1. Department of Neurosurgery, Taipei Veterans General Hospital, No. 201 Shi-Pai Rd., Sec. 2, Taipei, Taiwan

    David Hung-Chi Pan, Cheng-Chia Lee, Wen-Yuh Chung & Huai-Che Yang

  2. School of Medicine, National Yang-Ming University, Taipei, Taiwan

    David Hung-Chi Pan, Cheng-Chia Lee, Wen-Yuh Chung & Huai-Che Yang

  3. Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan

    Hsiu-Mei Wu & Chung-Jung Lin

Authors
  1. David Hung-Chi Pan
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  2. Cheng-Chia Lee
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  3. Hsiu-Mei Wu
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  4. Wen-Yuh Chung
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  5. Huai-Che Yang
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  6. Chung-Jung Lin
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Corresponding author

Correspondence to David Hung-Chi Pan .

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Editors and Affiliations

  1. , Fac. of Adv. Techno-Surgery, Tokyo Women's Medical University, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan

    Mikhail F. Chernov

  2. , Dept. of Neurosurgery, Tokyo Women's Medical University, Kawada-cho, Shinjuku-ku 8-1, Tokyo, 162-8666, Japan

    Motohiro Hayashi

  3. Oysteinsgate 16, Bergen, 5007, Norway

    Jeremy C. Ganz

  4. Kawada-cho, Shinjuku-ku 8-1, JP-162 8666 TOKYO, Japan

    Kintomo Takakura

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Pan, D.HC., Lee, CC., Wu, HM., Chung, WY., Yang, HC., Lin, CJ. (2013). Gamma Knife Radiosurgery for the Management of Intracranial Dural Arteriovenous Fistulas. In: Chernov, M., Hayashi, M., Ganz, J., Takakura, K. (eds) Gamma Knife Neurosurgery in the Management of Intracranial Disorders. Acta Neurochirurgica Supplement, vol 116. Springer, Vienna. https://doi.org/10.1007/978-3-7091-1376-9_18

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  • DOI: https://doi.org/10.1007/978-3-7091-1376-9_18

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  • Publisher Name: Springer, Vienna

  • Print ISBN: 978-3-7091-1375-2

  • Online ISBN: 978-3-7091-1376-9

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