Stereotactic radiosurgery and particulate embolization for cavernous sinusdural arteriovenous fistulae

OBJECTIVE: To evaluate the safety and efficacy of stereotactic radiosurgery , either with or without transarterial embolization, in the treatment of pa tients with dural arteriovenous fistulae (DAVFs) of the cavernous sinus. METHODS: We reviewed the findings, from a prospectively established databas e, for 20 patients with cavernous sinus DAVFs who were treated with either radiosurgery alone (n = 7) or radiosurgery and transarterial embolization ( n = 13) in a 7-year period. The median follow-up period after radiosurgery was 36 months (range, 4-59 mo). RESULTS: Nineteen of 20 patients (95%) experienced improvement of their cli nical symptoms. Fourteen of 15 patients (93%) experienced either total (n = 13) or nearly total (n = 1) obliteration of their DAVFs, as documented by angiography performed a median of 12 months after radiosurgery. No patient experienced a recurrence of symptoms after angiography showed DAVF oblitera tion. Two patients developed new neurological deficits after embolization p rocedures. One patient exhibited temporary aphasia secondary to a venous in farction; another patient exhibited permanent VIth cranial nerve weakness r elated to acute cavernous sinus thrombosis. Two patients experienced recurr ent symptoms and underwent repeat transarterial embolization at 7 and 12 mo nths; both patients achieved clinical and angiographic cures (5 and 10 mo l ater, respectively). One patient experienced recurrent visual symptoms and underwent transvenous embolization 4 months after radiosurgery. CONCLUSION: Staged radiosurgery and transarterial embolization provided bot h rapid symptom relief and longterm cures for patients with cavernous sinus DAVFs. Radiosurgery alone was effective for patients with DAVFs whose arte rial supply was not accessible via a transarterial approach, although the t ime course of symptom improvement was longer, compared with patients who al so underwent embolization.