• David Hung-Chi Pan, Cheng-Chia Lee, Hsiu-Mei Wu, Wen-Yuh Chung, Huai-Che Yang, and Chung-Jung Lin.
• Department of Neurosurgery, Taipei Veterans General Hospital, No. 201 Shi-Pai Rd., Sec. 2, Taipei, Taiwan. hcpan@vghtpe.gov.tw
• Acta Neurochir. Suppl. 2013 Jan 1; 116: 113-9.

BackgroundThis report presents our 15-year experience with Gamma Knife radiosurgery (GKS) for the treatment of 321 patients with dural arteriovenous fistulas (DAVFs) in different locations.MethodsThe most common locations of DAVFs were the cavernous sinus (206 cases) and transverse-sigmoid sinus (72 cases), which together accounted for 86.6 % of cases. In all, 54 patients had undergone embolization or surgery prior to radiosurgery, and the other patients underwent GKS as the primary treatment. During GKS, radiation was confined to the involved sinus wall, which was considered the true nidus of the DAVF. Target volume ranged from 0.8 to 52 cm(3). Marginal and maximum doses to the nidus ranged from 14 to 25 Gy and from 25 to 36 Gy, respectively.ResultsThe mean follow-up time was 28 months (range 2-149 months). In 264 of 321 patients (82 %) available for follow-up study, 173 (66 %) showed complete obliteration of DAVFs with symptomatic resolution, 87 (33 %) had partial obliteration, 2 (0.8 %) had stationary status, 1 (0.4 %) had progression, and 1 (0.4 %) died from a new hemorrhagic episode. Complications were found in only two (0.8 %) patients, one with venous hemorrhage and one with focal brain edema after GKS.ConclusionsGKS is a safe, effective treatment for DAVFs. It provides a minimally invasive therapeutic option for patients who harbor less-aggressive DAVFs but who suffer from intolerable clinical symptoms. For some aggressive DAVFs with extensive venous hypertension or hemorrhage, multimodal treatment with combined embolization or surgery is necessary.

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