Stereotactic Radiosurgery for Dural Carotid Cavernous Sinus Fistulas

Area of Science:

• Neurosurgery
• Radiation Oncology
• Vascular Neurology

Background:

• Dural carotid cavernous fistulas (DCCFs) are abnormal connections between arteries and veins in the dura mater.
• Treatment options for DCCFs include embolization, microsurgery, and stereotactic radiosurgery (SRS).
• SRS offers a minimally invasive approach for DCCFs, particularly those unsuitable for conventional treatments.

Purpose of the Study:

• To evaluate the efficacy and safety of stereotactic radiosurgery (SRS) as a standalone treatment for dural carotid cavernous fistulas (DCCFs).
• To analyze clinical outcomes, complication rates, and angiographic results following SRS for DCCFs.
• To identify factors associated with symptom improvement after SRS treatment for DCCFs.

Main Methods:

• Retrospective analysis of 18 consecutive patients with DCCFs treated with Gamma Knife SRS between 2009 and 2015.
• Median target volume: 2.6 cm³; median radiation dose: 17 Gy.
• Median follow-up: 30 months.

Main Results:

• High obliteration rates: 83% total, 17% subtotal.
• Total obliteration achieved in 53% at 1 year and 90% at 2 years.
• Symptom recovery in 67% of patients, with significant neurologic improvement rates within 6 months. No radiation-related complications reported. Absence of hypertension, seizure, and cortical venous drainage were associated with symptom improvement.

Conclusions:

• Stereotactic radiosurgery (SRS) provides a safe and highly effective treatment for dural carotid cavernous fistulas (DCCFs).
• SRS achieves excellent obliteration rates and promotes significant symptom recovery with a low risk of complications.
• SRS is a valuable therapeutic option for DCCFs, especially when embolization or microsurgery are not feasible, improving patients' quality of life.