Hirai T, Korogi Y, Baba Y, Nishimura R, Hamatake S, Kawanaka K, Bussaka H, Takahashi M
Department of Radiology, Kumamoto University School of Medicine, Japan.
Radiology. 1998 May;207(2):423-30. doi: 10.1148/radiology.207.2.9577491.
To evaluate the long-term results of irradiation alone or of embolization with or without irradiation in patients with dural carotid cavernous fistulas (DCCFs).
Between 1984 and 1996, symptomatic DCCFs in 26 patients were treated by using irradiation alone (protocol 1, n = 12) before April 1988 and by using embolization as an initial treatment (protocol 2, n = 14) during and after April 1988. When angiography showed no improvement after embolization, irradiation was added (n = 6). On the basis of drainage flow speed, DCCFs were classified as fast, medium, or slow.
With irradiation alone, all six patients with slow- to medium-type DCCFs had cure with a mean follow-up of 62 months. Four of six patients with fast-type DCCFs had cure or improvement, but the remaining two had no change. In the embolization group, irradiation was added in six patients with fast-type DCCFs. With a mean follow-up of 24 months, four of the six patients had cures, one had improvement, and one had no clinical change. Those who underwent protocol 2 had cures significantly earlier than those who underwent protocol 1 (P < .05).
Conventional radiation therapy resulted in cure of DCCFs in nine (75%) of the 12 patients and in improvement of signs and symptoms in one (8%). Fast-type DCCFs may not always be improved. Radiation therapy may be useful in DCCFs after embolization.
评估单纯放疗或联合或不联合放疗的栓塞治疗对硬脑膜动静脉瘘（DCCF）患者的长期疗效。
1984年至1996年间，26例有症状的DCCF患者，1988年4月前采用单纯放疗（方案1，n = 12），1988年4月及以后采用栓塞作为初始治疗（方案2，n = 14）。栓塞后血管造影显示无改善时，加用放疗（n = 6）。根据引流血流速度，将DCCF分为快、中、慢三型。
单纯放疗时，6例中-慢型DCCF患者均治愈，平均随访62个月。6例快型DCCF患者中，4例治愈或改善，其余2例无变化。栓塞组中，6例快型DCCF患者加用了放疗。平均随访24个月，6例患者中4例治愈，1例改善，1例无临床变化。接受方案2治疗的患者比接受方案1治疗的患者治愈时间明显更早（P < .05）。
传统放疗使12例患者中的9例（75%）DCCF治愈，1例（8%）患者的体征和症状改善。快型DCCF可能并非总能改善。放疗可能对栓塞后的DCCF有用。
