Pan David Hung-chi, Chung Wen-yuh, Guo Wan-you, Wu Hsiu-mei, Liu Kang-du, Shiau Cheng-ying, Wang Ling-wei
Department of Neurosurgery, Veterans General Hospital-Taipei, VACRS, Taiwan, Republic of China.
J Neurosurg. 2002 May;96(5):823-9. doi: 10.3171/jns.2002.96.5.0823.
The aim of this study was to assess the efficacy and safety of radiosurgery for the treatment of dural arteriovenous fistulas (DAVFs) located in the region of the transverse-sigmoid sinus.
A series of 20 patients with DAVFs located in the transverse-sigmoid sinus, who were treated with gamma knife surgery between June 1995 and June 2000, was evaluated. According to the Cognard classification, the DAVF was Type I in four patients. Type IIa in seven, Type IIb in two, and combined Type IIa+b in seven. Nine patients had previously been treated with surgery and/or embolization, whereas 11 patients underwent radiosurgery alone. Radiosurgery was performed using multiple-isocenter irradiation of the delineated DAVF nidus. The target volume ranged from 1.7 to 40.7 cm3. The margin dose delivered to the nidus ranged from 16.5 to 19 Gy at a 50 to 70% isodose level. Nineteen patients were available for follow-up review, the duration of which ranged from 6 to 58 months (median 19 months). Of the 19 patients, 14 (74%) were cured of their symptoms. At follow up, magnetic resonance imaging and/or angiography demonstrated complete obliteration of the DAVF in 11 patients (58%), subtotal obliteration (95% reduction of the nidus) in three (16%), and partial obliteration in another five (26%). There was no neurological complication related to the treatment. One patient experienced a recurrence of the DAVF 18 months after angiographic confirmation of total obliteration, and underwent a second course of radiosurgery.
Stereotactic radiosurgery provides a safe and effective option for the treatment of DAVFs involving the transverse and sigmoid sinuses. For some aggressive DAVFs with extensive retrograde cortical venous drainage, however, a combination of endovascular embolization and surgery may be necessary.
本研究旨在评估放射外科治疗横窦 - 乙状窦区域硬脑膜动静脉瘘（DAVF）的有效性和安全性。
对1995年6月至2000年6月间接受伽玛刀手术治疗的20例横窦 - 乙状窦区域DAVF患者进行评估。根据Cognard分类，4例患者为I型DAVF，7例为IIa型，2例为IIb型，7例为IIa + b型。9例患者曾接受过手术和/或栓塞治疗，而11例患者仅接受了放射外科治疗。采用多中心照射划定的DAVF病灶进行放射外科治疗。靶体积范围为1.7至40.7 cm³。在50%至70%等剂量水平下，给予病灶的边缘剂量范围为16.5至19 Gy。19例患者可进行随访复查，随访时间为6至58个月（中位时间19个月）。19例患者中，14例（74%）症状得到治愈。随访时，磁共振成像和/或血管造影显示11例患者（58%）的DAVF完全闭塞，3例患者（16%）次全闭塞（病灶缩小95%），另外5例患者（26%）部分闭塞。没有与治疗相关的神经并发症。1例患者在血管造影证实完全闭塞18个月后出现DAVF复发，并接受了第二疗程的放射外科治疗。
立体定向放射外科为治疗累及横窦和乙状窦的DAVF提供了一种安全有效的选择。然而，对于一些具有广泛逆行皮质静脉引流的侵袭性DAVF，可能需要联合血管内栓塞和手术治疗。
