Stereotactic Radiosurgery for Dural Arteriovenous Fistulas without Cortical Venous Reflux

The rationale for treatment of dural arteriovenous fistulas (dAVFs) without cortical venous reflux is symptomatic resolution. Most studies of dAVF treatment, including those for stereotactic radiosurgery, have focused on angiographic obliteration instead of clinical symptomatic outcome. The authors...

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Bibliographic Details
Published in:World neurosurgery 2017-11, Vol.107, p.371-375
Main Authors: Tonetti, Daniel A., Gross, Bradley A., Jankowitz, Brian T., Atcheson, Kyle M., Kano, Hideyuki, Monaco, Edward A., Niranjan, Ajay, Lunsford, L. Dade
Format: Article
Language:English
Subjects:
Adult
Aged
Arteriovenous fistula
Central Nervous System Vascular Malformations - diagnostic imaging
Central Nervous System Vascular Malformations - surgery
Cerebral Veins - diagnostic imaging
dAVF
Dural arteriovenous fistula
Female
Follow-Up Studies
Humans
Male
Middle Aged
Prospective Studies
Radiosurgery
Radiosurgery - methods
SRS
Tinnitus
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Summary:The rationale for treatment of dural arteriovenous fistulas (dAVFs) without cortical venous reflux is symptomatic resolution. Most studies of dAVF treatment, including those for stereotactic radiosurgery, have focused on angiographic obliteration instead of clinical symptomatic outcome. The authors evaluated their institutional experience with stereotactic radiosurgery for cerebral dAVFs without cortical venous reflux from 1991 to 2016, evaluating angiographic and clinical outcomes, focusing on the course of pulsatile tinnitus and/or ocular symptoms after treatment. They subsequently pooled their results with those from a systematic literature review. Pooled outcomes data from 349 low-risk dAVF (120 patients with pulsatile tinnitus and 229 patients with ocular symptoms) were analyzed. Over a mean follow-up of 2.6 years, 77% of patients presenting with pulsatile tinnitus experienced resolution and an additional 21% had improvement, with an angiographic obliteration rate of 70.9%. Among 229 patients with ocular symptoms from carotid-cavernous dAVFs, improvement or resolution of symptoms occurred in 95% of those with chemosis, 90% of those with ophthalmoparesis, and 96% of those with proptosis. The angiographic obliteration rate was 76.2%. There were six permanent complications in 349 total treated low-risk dAVF (1.7%). Rates of clinically significant symptomatic improvement/resolution of symptoms referable to “low-risk” dAVFs are even greater than their angiographic obliteration rate, an important factor in patient counseling and when considering the optimal treatment approach for these dAVFs.
ISSN:1878-8750
1878-8769
DOI:10.1016/j.wneu.2017.07.170