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J Neurol Surg A Cent Eur Neurosurg
DOI: 10.1055/a-2235-5256
Original Article

Radiosurgery as a Stand-Alone Treatment Option for Cerebral Dural Arteriovenous Fistulas: the Vienna Series

Beate Kranawetter‡   *
1   Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
2   Department of Neurosurgery, University Medical Center Göttingen, Göttingen, Germany
,
Anna Cho‡   *
1   Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
,
Dorian Hirschmann
1   Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
,
Philipp Göbl
1   Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
,
Christian Dorfer 
1   Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
,
Karl Rössler
1   Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
,
Philippe Dodier
1   Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
,
Wei-Te Wang
1   Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
,
Brigitte Gatterbauer
1   Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
,
Andreas Gruber
3   Department of Neurosurgery, Kepler University Hospital Linz, Linz, Austria
,
Klaus Kitz
1   Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
,
Josa M. Frischer
1   Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
› Author Affiliations Funding A part of this work was supported by the Medical Scientific Fund of the Mayor of the City of Vienna (Project no. 18096).
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Abstract

Background Gamma Knife radiosurgery (GKRS) has been demonstrated to be an effective and safe treatment method for dural arteriovenous fistulas (DAVFs). However, only few studies, mostly with limited patient numbers, have evaluated radiosurgery as a sole and upfront treatment option for DAVFs.

Methods Thirty-three DAVF patients treated with GKRS as a stand-alone management at our institution between January 1992 and January 2020 were included in this study. Obliteration rates, time to obliteration, neurologic outcome, and complications were evaluated retrospectively.

Results Complete overall obliteration was achieved in 20/28 (71%) patients. The postradiosurgery actuarial rates of obliteration at 2, 5, and 10 years were 53, 71, and 85%, respectively. No difference in time to obliteration between carotid–cavernous fistulas (CCFs; 14/28, 50%, 17 months; 95% confidence interval [CI]: 7.4–27.2) and non-CCFs (NCCFs; 14/28, 50%, 37 months; 95% CI: 34.7–38.5; p = 0.111) were found. Overall, the neurologic outcome in our series was highly favorable at the time of the last follow-up. A complete resolution of symptoms was seen in two-thirds (20/30, 67%) of patients. One patient with multiple DAVFs suffered from an intracranial hemorrhage of the untreated lesion and died during the follow-up period, resulting in a yearly bleeding risk of 0.5%. No complications after radiosurgery were observed in our series.

Conclusion Our results show that GKRS is a safe and effective stand-alone management option for selected DAVF patients.

Keywords

carotid–cavernous fistula - dural arteriovenous fistula - Gamma Knife radiosurgery

* These authors contributed equally to this work.




Publication History

Received: 16 February 2023

Accepted: 20 December 2023

Accepted Manuscript online:
27 December 2023

Article published online:
04 March 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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