Gamma Knife surgery for clival epidural-osseous dural arteriovenous fistulas

Cheng Chia Lee, Ching Jen Chen, Shao Ching Chen, Huai Che Yang, Chung Jung Lin, Chih Chun Wu, Wen Yuh Chung, Wan Yuo Guo, David Hung Chi Pan, Cheng Ying Shiau, Hsiu Mei Wu

研究成果: 雜誌貢獻文章

1 引文 (Scopus)

摘要

OBJECTIVE Clival epidural-osseous dural arteriovenous fistula (DAVF) is often associated with a large nidus, multiple arterial feeders, and complex venous drainage. In this study the authors report the outcomes of clival epidural-osseous DAVFs treated using Gamma Knife surgery (GKS). METHODS Thirteen patients with 13 clival epidural-osseous DAVFs were treated with GKS at the authors' institution between 1993 and 2015. Patient age at the time of GKS ranged from 38 to 76 years (median 55 years). Eight DAVFs were classified as Cognard Type I, 4 as Type IIa, and 1 as Type IIa+b. The median treatment volume was 17.6 cm3 (range 6.2-40.3 cm3). The median prescribed margin dose was 16.5 Gy (range 15-18 Gy). Clinical and radiological follow-ups were performed at 6-month intervals. Patient outcomes after GKS were categorized as 1) complete improvement, 2) partial improvement, 3) stationary, and 4) progression. RESULTS All 13 patients demonstrated symptomatic improvement, and on catheter angiography 12 of the 13 patients had complete obliteration and 1 patient had partial obliteration. The median follow-up period was 26 months (range 14-186 months). The median latency period from GKS to obliteration was 21 months (range 8-186 months). There was no intracranial hemorrhage during the follow-up period, and no deaths occurred. Two adverse events were observed following treatment, and 2 patients required repeat GKS treatment with eventual complete obliteration. CONCLUSIONS Gamma Knife surgery offers a safe and effective primary or adjuvant treatment modality for complex clival epidural-osseous DAVFs. All patients in this case series demonstrated symptomatic improvement, and almost all patients attained complete obliteration.

原文英語
頁(從 - 到)1364-1371
頁數8
期刊Journal of Neurosurgery
128
發行號5
DOIs
出版狀態已發佈 - 五月 1 2018

指紋

Central Nervous System Vascular Malformations
Intracranial Hemorrhages
Therapeutics
Drainage
Angiography
Catheters

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

引用此文

Lee, C. C., Chen, C. J., Chen, S. C., Yang, H. C., Lin, C. J., Wu, C. C., ... Wu, H. M. (2018). Gamma Knife surgery for clival epidural-osseous dural arteriovenous fistulas. Journal of Neurosurgery, 128(5), 1364-1371. https://doi.org/10.3171/2017.1.JNS161346

Gamma Knife surgery for clival epidural-osseous dural arteriovenous fistulas. / Lee, Cheng Chia; Chen, Ching Jen; Chen, Shao Ching; Yang, Huai Che; Lin, Chung Jung; Wu, Chih Chun; Chung, Wen Yuh; Guo, Wan Yuo; Pan, David Hung Chi; Shiau, Cheng Ying; Wu, Hsiu Mei.

於: Journal of Neurosurgery, 卷 128, 編號 5, 01.05.2018, p. 1364-1371.

研究成果: 雜誌貢獻文章

Lee, CC, Chen, CJ, Chen, SC, Yang, HC, Lin, CJ, Wu, CC, Chung, WY, Guo, WY, Pan, DHC, Shiau, CY & Wu, HM 2018, 'Gamma Knife surgery for clival epidural-osseous dural arteriovenous fistulas', Journal of Neurosurgery, 卷 128, 編號 5, 頁 1364-1371. https://doi.org/10.3171/2017.1.JNS161346
Lee, Cheng Chia ; Chen, Ching Jen ; Chen, Shao Ching ; Yang, Huai Che ; Lin, Chung Jung ; Wu, Chih Chun ; Chung, Wen Yuh ; Guo, Wan Yuo ; Pan, David Hung Chi ; Shiau, Cheng Ying ; Wu, Hsiu Mei. / Gamma Knife surgery for clival epidural-osseous dural arteriovenous fistulas. 於: Journal of Neurosurgery. 2018 ; 卷 128, 編號 5. 頁 1364-1371.
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abstract = "OBJECTIVE Clival epidural-osseous dural arteriovenous fistula (DAVF) is often associated with a large nidus, multiple arterial feeders, and complex venous drainage. In this study the authors report the outcomes of clival epidural-osseous DAVFs treated using Gamma Knife surgery (GKS). METHODS Thirteen patients with 13 clival epidural-osseous DAVFs were treated with GKS at the authors' institution between 1993 and 2015. Patient age at the time of GKS ranged from 38 to 76 years (median 55 years). Eight DAVFs were classified as Cognard Type I, 4 as Type IIa, and 1 as Type IIa+b. The median treatment volume was 17.6 cm3 (range 6.2-40.3 cm3). The median prescribed margin dose was 16.5 Gy (range 15-18 Gy). Clinical and radiological follow-ups were performed at 6-month intervals. Patient outcomes after GKS were categorized as 1) complete improvement, 2) partial improvement, 3) stationary, and 4) progression. RESULTS All 13 patients demonstrated symptomatic improvement, and on catheter angiography 12 of the 13 patients had complete obliteration and 1 patient had partial obliteration. The median follow-up period was 26 months (range 14-186 months). The median latency period from GKS to obliteration was 21 months (range 8-186 months). There was no intracranial hemorrhage during the follow-up period, and no deaths occurred. Two adverse events were observed following treatment, and 2 patients required repeat GKS treatment with eventual complete obliteration. CONCLUSIONS Gamma Knife surgery offers a safe and effective primary or adjuvant treatment modality for complex clival epidural-osseous DAVFs. All patients in this case series demonstrated symptomatic improvement, and almost all patients attained complete obliteration.",
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AU - Lee, Cheng Chia

AU - Chen, Ching Jen

AU - Chen, Shao Ching

AU - Yang, Huai Che

AU - Lin, Chung Jung

AU - Wu, Chih Chun

AU - Chung, Wen Yuh

AU - Guo, Wan Yuo

AU - Pan, David Hung Chi

AU - Shiau, Cheng Ying

AU - Wu, Hsiu Mei

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N2 - OBJECTIVE Clival epidural-osseous dural arteriovenous fistula (DAVF) is often associated with a large nidus, multiple arterial feeders, and complex venous drainage. In this study the authors report the outcomes of clival epidural-osseous DAVFs treated using Gamma Knife surgery (GKS). METHODS Thirteen patients with 13 clival epidural-osseous DAVFs were treated with GKS at the authors' institution between 1993 and 2015. Patient age at the time of GKS ranged from 38 to 76 years (median 55 years). Eight DAVFs were classified as Cognard Type I, 4 as Type IIa, and 1 as Type IIa+b. The median treatment volume was 17.6 cm3 (range 6.2-40.3 cm3). The median prescribed margin dose was 16.5 Gy (range 15-18 Gy). Clinical and radiological follow-ups were performed at 6-month intervals. Patient outcomes after GKS were categorized as 1) complete improvement, 2) partial improvement, 3) stationary, and 4) progression. RESULTS All 13 patients demonstrated symptomatic improvement, and on catheter angiography 12 of the 13 patients had complete obliteration and 1 patient had partial obliteration. The median follow-up period was 26 months (range 14-186 months). The median latency period from GKS to obliteration was 21 months (range 8-186 months). There was no intracranial hemorrhage during the follow-up period, and no deaths occurred. Two adverse events were observed following treatment, and 2 patients required repeat GKS treatment with eventual complete obliteration. CONCLUSIONS Gamma Knife surgery offers a safe and effective primary or adjuvant treatment modality for complex clival epidural-osseous DAVFs. All patients in this case series demonstrated symptomatic improvement, and almost all patients attained complete obliteration.

AB - OBJECTIVE Clival epidural-osseous dural arteriovenous fistula (DAVF) is often associated with a large nidus, multiple arterial feeders, and complex venous drainage. In this study the authors report the outcomes of clival epidural-osseous DAVFs treated using Gamma Knife surgery (GKS). METHODS Thirteen patients with 13 clival epidural-osseous DAVFs were treated with GKS at the authors' institution between 1993 and 2015. Patient age at the time of GKS ranged from 38 to 76 years (median 55 years). Eight DAVFs were classified as Cognard Type I, 4 as Type IIa, and 1 as Type IIa+b. The median treatment volume was 17.6 cm3 (range 6.2-40.3 cm3). The median prescribed margin dose was 16.5 Gy (range 15-18 Gy). Clinical and radiological follow-ups were performed at 6-month intervals. Patient outcomes after GKS were categorized as 1) complete improvement, 2) partial improvement, 3) stationary, and 4) progression. RESULTS All 13 patients demonstrated symptomatic improvement, and on catheter angiography 12 of the 13 patients had complete obliteration and 1 patient had partial obliteration. The median follow-up period was 26 months (range 14-186 months). The median latency period from GKS to obliteration was 21 months (range 8-186 months). There was no intracranial hemorrhage during the follow-up period, and no deaths occurred. Two adverse events were observed following treatment, and 2 patients required repeat GKS treatment with eventual complete obliteration. CONCLUSIONS Gamma Knife surgery offers a safe and effective primary or adjuvant treatment modality for complex clival epidural-osseous DAVFs. All patients in this case series demonstrated symptomatic improvement, and almost all patients attained complete obliteration.

KW - Dural arteriovenous fistula

KW - Epidural

KW - Gamma Knife

KW - Osseous

KW - Stereotactic radiosurgery

KW - Treatment outcome

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