• Yuki Shinya, Hirotaka Hasegawa, Mariko Kawashima, Satoshi Koizumi, Atsuto Katano, Motoyuki Umekawa, and Nobuhito Saito.
• Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan.
• Neurosurgery. 2023 Jan 1; 92 (1): 167178167-178.

BackgroundCerebral dural arteriovenous fistulas (DAVFs) are intracranial vascular malformations with fine, abnormal vascular architecture. High-resolution vascular imaging is vital for their visualization. Currently, rotational angiography (RA) provides the finest 3-dimensional visualization of the arteriovenous shunt with high spatial resolution; however, the efficacies of the integration of RA have never been studied in stereotactic radiosurgery (SRS) for DAVFs until now. Since 2015, our institution has integrated RA into SRS (RA-SRS) to provide more conformal planning, thereby decreasing overtreatment and undertreatment.ObjectiveTo analyze the outcomes of RA-SRS for DAVFs.MethodsWe retrospectively analyzed the outcomes of 51 patients with DAVFs and compared those of 20 DAVFs treated with RA-SRS with those of 31 DAVFs treated with conventional SRS (c-SRS).ResultsThe time to obliteration was shorter in the RA-SRS group (median, 15 months vs 26 months [cumulative rate, 77% vs 33% at 2 years, 77% vs 64% at 4 years]; P = .015). Multivariate Cox proportional hazards analysis demonstrated that RA-SRS (hazard ratio 2.39, 95% CI 1.13-5.05; P = .022) and the absence of cortical venous reflux (hazard ratio 2.12, 95% CI 1.06-4.25; P = .034) were significantly associated with obliteration. The cumulative 5-year post-SRS stroke-free survival rates were 95% and 97% in the RA-SRS and c-SRS groups, respectively ( P = .615). Neurological improvement tended to occur earlier in the RA-SRS group than in the c-SRS group (median time to improvement, 5 months vs 20 months, log-rank test; P = .077).ConclusionRA-based SRS may facilitate earlier fistula obliteration and may contribute to early neurological improvement.Copyright © Congress of Neurological Surgeons 2022. All rights reserved.

27 keywords...

hide…