| Autor: |
Park, Ki-Su, Kang, Dong-Hun, Park, Seong-Hyun, Kim, Yong-Sun |
| Předmět: |
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| Zdroj: |
Acta Neurochirurgica; Apr2016, Vol. 158 Issue 4, p821-828, 8p, 1 Color Photograph, 2 Diagrams, 4 Charts |
| Abstrakt: |
Background: The application of gamma knife radiosurgery (GKRS) alone has been expanded for dural arteriovenous fistulas (DAVFs). However, a standardized protocol delineating the appropriate circumstances for GKRS alone in cases of DAVF has yet to be determined. The purpose of this study was to report a single center's treatment algorithm for GKRS alone as a primary treatment for intracranial DAVFs and assess related clinical and radiological data. Method: Among 31 DAVF patients treated according to our institute's treatment algorithm between February 2009 and November 2014, 20 patients underwent GKRS alone. DAVF patients treated with GKRS alone fell in two main subgroups: DAVF patients without cortical venous reflux (CVR) but with symptoms ( n = 8) and DAVF patients with CVR but without a high bleeding risk (defined as CVR with aggressive symptoms including hemorrhage or non-hemorrhagic neurological deficit, n = 11). One DAVF patient with a high bleeding risk had GKRS alone because of difficult endovascular access. Mean radiation volume was 4.8 cc (range, 0.7-14.2 cc), and mean maximal dose was 33.5 Gy (range, 28-38 Gy). Results: At mean follow-up of 29.1 months (range, 8-69 months), radiological findings demonstrated complete cures in 18 patients (90 %) and subtotal cures in 2 patients (10 %). One patient had a transient complication, but no neurologic sign. All symptomatic patients showed complete resolution. Conclusions: Our treatment algorithm showed GKRS alone may serve as a primary treatment for patients with DAVFs regardless of location and presence of CVR, unless there is a high bleeding risk. However, a multicenter, prospective study is necessary to generalize our treatment algorithm. [ABSTRACT FROM AUTHOR] |
| Databáze: |
Complementary Index |
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