Abstract TMP119: Stereotactic Radiosurgery For Dural Arteriovenous Fistula Reflactory To Endovascular Treatment

Abstract

Background: Although almost all dural arteriovenous fistulas (DAVFs) can be highly curable using endovascular treatment, some of them are reflactory. We evaluated the efficacy of stereotactic radiosurgery for DAVFs reflactory to endovascular treatment. Methods: In 178 patients with DAVFs treated by endovascular embolization in our institution, 12 patients were reflactory and treated by CyberKnife (CK) radiosurgery. Patients background, efficacy of CyberKnife radiosurgery and complication were analyzed. Results: 5 men and 7 women underwent CyberKnife radiosurgery. Ages ranged from 21 to 74 years (mean, 57.5 years). The locations of the fistulas were 10 transverse/sigmoid sinus and 2 cavernous sinus. The Borden classification was I in 3, II in 6, and III in 3 patients. Transarterial embolization (TAE) was performed in 10 patients, TAE and transvenous embolization (TVE) in 2. In all cases, shunt flow could be reduced, but small flow was residual. After embolization, residual fistula was treated by CK with a mean marginal dose of 19.95 Gy. Nine patients could follow up over two years. 8 patients got complete disappearance of the nidus. One patient remained small nidus, but him symptom improved. There was no complication accompanying radiosurgery. Conclusions: CyberKnife radiosurgery to residual DAVFs after endovascular treatment showed a remarkable response at high rates in long term. CyberKnife radiosurgery is a safe and effective method of these reflactory and mildly symptomatic patients.