Wu Hsiu-Mei, Pan David Hung-Chi, Chung Wen-Yuh, Guo Wan-Yuo, Liu Kang-Du, Shiau Cheng-Ying, Wang Ling-Wei, Chen Shih-Jen
Department of Radiology, Taipei Veterans General Hospital, VACRS, Taipei, Taiwan, Republic of China.
J Neurosurg. 2006 Dec;105 Suppl:43-51. doi: 10.3171/sup.2006.105.7.43.
The purpose of this study was to assess the efficacy and safety of Gamma Knife surgery (GKS) for the treatment of cavernous sinus dural arteriovenous fistulas (CSDAVFs) and other intracranial dural arteriovenous fistulas (ODAVFs).
Among the 238 GKS procedures performed for intracranial DAVFs in the authors' institute, 227 cases (146 CSDAVFs and 81 OIDAVFs) with clinical follow up formed the database from which the authors determined clinical outcome and the incidence of untoward events. One hundred ninety-five cases (118 CSDAVFs and 77 ODAVFs) with imaging follow up formed the database from which the authors determined the imaging results. Older age, female sex, higher incidence of diabetes, and shorter duration of symptoms were noted more in cases of CSDAVF than in ODAVFs. Most patients had symptomatic improvement after GKS. A symptomatic cure was observed in one patient with CSDAVFs as early as 6 weeks. The cumulative cure rate based on follow-up angiography of CSDAVFs approached 75% at 24 months, which was much better than that of ODAVFs (approximately 50% at 24 months). A neuroimaging-based cure lagged behind that of the clinical symptoms. Overall, there were only two nonfatal intracerebral hemorrhages during the follow-up period, both occurring less than 1 week after GKS and both being Cognard Type IIa+b with initial aggressive symptoms. Transient deterioration of neurological status without hemorrhage was noted in six patients with ODAVFs. Thrombosis of the superior ophthalmic vein occurred in 11 patients with CSDAVFs, in two of whom there were unilateral visual impairments. There were three cranial nerve neuropathies: transient in one CSDAVF and one ODAVF involving the jugular foramen, and another one was a CSDAVF previously treated by conventional radiotherapy.
Gamma Knife surgery provides a safe and effective option for treatment of intracranial DAVFs with a low risk of complications. In cases of DAVFs with benign clinical presentation, GKS can serve as a primary treatment. In some cases of aggressive DAVFs in which there is extensive retrograde cortical vein drainage, combined treatment with embolization or surgery is suggested.
本研究旨在评估伽玛刀手术（GKS）治疗海绵窦硬脑膜动静脉瘘（CSDAVF）及其他颅内硬脑膜动静脉瘘（ODAVF）的疗效和安全性。
在作者所在机构进行的238例颅内DAVF的GKS手术中，227例（146例CSDAVF和８１例ODAVF）有临床随访资料，构成了作者用以确定临床结果和不良事件发生率的数据库。195例（118例CSDAVF和77例ODAVF）有影像学随访资料，构成了作者用以确定影像学结果的数据库。与ODAVF相比，CSDAVF患者年龄更大、女性更多、糖尿病发病率更高且症状持续时间更短。大多数患者在GKS术后症状改善。1例CSDAVF患者早在6周时就实现了症状治愈。基于随访血管造影，CSDAVF在24个月时的累积治愈率接近75%，远高于ODAVF（24个月时约为50%）。基于神经影像学的治愈滞后于临床症状。总体而言，随访期间仅发生2例非致命性脑出血，均发生在GKS术后不到1周，均为Cognard IIa + b型且初始症状严重。6例ODAVF患者出现无出血的神经功能状态短暂恶化。11例CSDAVF患者发生眼上静脉血栓形成，其中2例出现单侧视力损害。有3例脑神经病变：1例CSDAVF和1例涉及颈静脉孔的ODAVF为短暂性病变，另1例是先前接受过传统放疗的CSDAVF。
伽玛刀手术为治疗颅内DAVF提供了一种安全有效的选择，并发症风险低。对于临床表现良性的DAVF病例，GKS可作为主要治疗方法。在一些具有广泛逆行皮质静脉引流的侵袭性DAVF病例中，建议联合栓塞或手术治疗。
