Cargando…

Gamma Knife Radiosurgery for Indirect Dural Carotid–Cavernous Fistula: Long-Term Ophthalmological Outcome

Objective: The leading treatment option for dural carotid–cavernous sinus fistula is an endovascular approach with immediate improvement. Alternatively, radiosurgery is a slow response for obliterating the fistula and poses a radiation risk to the optic apparatus and the associated cranial nerves an...

Descripción completa

Detalles Bibliográficos
Autores principales: Shen, Chiung-Chyi, Tsuei, Yuang-Seng, Yang, Meng-Yin, You, Weir-Chiang, Sun, Ming-His, Sheu, Meei-Ling, Pan, Liang-Yi, Sheehan, Jason, Pan, Hung-Chuan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9410130/
https://www.ncbi.nlm.nih.gov/pubmed/36013354
http://dx.doi.org/10.3390/life12081175
_version_ 1784775019634622464
author Shen, Chiung-Chyi
Tsuei, Yuang-Seng
Yang, Meng-Yin
You, Weir-Chiang
Sun, Ming-His
Sheu, Meei-Ling
Pan, Liang-Yi
Sheehan, Jason
Pan, Hung-Chuan
author_facet Shen, Chiung-Chyi
Tsuei, Yuang-Seng
Yang, Meng-Yin
You, Weir-Chiang
Sun, Ming-His
Sheu, Meei-Ling
Pan, Liang-Yi
Sheehan, Jason
Pan, Hung-Chuan
author_sort Shen, Chiung-Chyi
collection PubMed
description Objective: The leading treatment option for dural carotid–cavernous sinus fistula is an endovascular approach with immediate improvement. Alternatively, radiosurgery is a slow response for obliterating the fistula and poses a radiation risk to the optic apparatus and the associated cranial nerves and blood vessels. In this study, we retrieved cases from a prospective database to assess the ophthalmological outcomes and complications in treating dural carotid cavernous sinus fistula with gamma knife radiosurgery (GKRS). Material and Methods: We retrieved a total of 65 cases of carotid cavernous sinus fistula treated with GKRS with margin dose of 18–20 Gy from 2003 to 2018 and reviewed the ophthalmological records required for our assessment. Results: The mean target volume was 2 ± 1.43 cc. The onset of symptom alleviated after GKRS was 3.71 ± 7.68 months. There were two cases with residual chemosis, two with cataract, two with infarction, one with transient optic neuropathy, and four with residual cranial nerve palsy, but none with glaucoma or dry eyes. In MRA analysis, total obliteration of the fistula was noted in 64 cases with no detectable ICA stenosis nor cavernous sinus thrombosis. In the Cox regression analysis, post-GKRS residual cranial nerve palsy was highly correlated to targeted volume (p < 0.05) and age (p < 0.05). The occurrence of post-GKRS cataract was related to the initial symptom of chemosis (p < 0.05). Conclusion: GKRS for carotid cavernous sinus fistula offers a high obliteration rate and preserves the cavernous sinus vascular structure while conferring a low risk of treatment complications such as adverse radiation risk to the optic apparatus and adjacent cranial nerves.
format Online
Article
Text
id pubmed-9410130
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher MDPI
record_format MEDLINE/PubMed
spelling pubmed-94101302022-08-26 Gamma Knife Radiosurgery for Indirect Dural Carotid–Cavernous Fistula: Long-Term Ophthalmological Outcome Shen, Chiung-Chyi Tsuei, Yuang-Seng Yang, Meng-Yin You, Weir-Chiang Sun, Ming-His Sheu, Meei-Ling Pan, Liang-Yi Sheehan, Jason Pan, Hung-Chuan Life (Basel) Article Objective: The leading treatment option for dural carotid–cavernous sinus fistula is an endovascular approach with immediate improvement. Alternatively, radiosurgery is a slow response for obliterating the fistula and poses a radiation risk to the optic apparatus and the associated cranial nerves and blood vessels. In this study, we retrieved cases from a prospective database to assess the ophthalmological outcomes and complications in treating dural carotid cavernous sinus fistula with gamma knife radiosurgery (GKRS). Material and Methods: We retrieved a total of 65 cases of carotid cavernous sinus fistula treated with GKRS with margin dose of 18–20 Gy from 2003 to 2018 and reviewed the ophthalmological records required for our assessment. Results: The mean target volume was 2 ± 1.43 cc. The onset of symptom alleviated after GKRS was 3.71 ± 7.68 months. There were two cases with residual chemosis, two with cataract, two with infarction, one with transient optic neuropathy, and four with residual cranial nerve palsy, but none with glaucoma or dry eyes. In MRA analysis, total obliteration of the fistula was noted in 64 cases with no detectable ICA stenosis nor cavernous sinus thrombosis. In the Cox regression analysis, post-GKRS residual cranial nerve palsy was highly correlated to targeted volume (p < 0.05) and age (p < 0.05). The occurrence of post-GKRS cataract was related to the initial symptom of chemosis (p < 0.05). Conclusion: GKRS for carotid cavernous sinus fistula offers a high obliteration rate and preserves the cavernous sinus vascular structure while conferring a low risk of treatment complications such as adverse radiation risk to the optic apparatus and adjacent cranial nerves. MDPI 2022-08-01 /pmc/articles/PMC9410130/ /pubmed/36013354 http://dx.doi.org/10.3390/life12081175 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Shen, Chiung-Chyi
Tsuei, Yuang-Seng
Yang, Meng-Yin
You, Weir-Chiang
Sun, Ming-His
Sheu, Meei-Ling
Pan, Liang-Yi
Sheehan, Jason
Pan, Hung-Chuan
Gamma Knife Radiosurgery for Indirect Dural Carotid–Cavernous Fistula: Long-Term Ophthalmological Outcome
title Gamma Knife Radiosurgery for Indirect Dural Carotid–Cavernous Fistula: Long-Term Ophthalmological Outcome
title_full Gamma Knife Radiosurgery for Indirect Dural Carotid–Cavernous Fistula: Long-Term Ophthalmological Outcome
title_fullStr Gamma Knife Radiosurgery for Indirect Dural Carotid–Cavernous Fistula: Long-Term Ophthalmological Outcome
title_full_unstemmed Gamma Knife Radiosurgery for Indirect Dural Carotid–Cavernous Fistula: Long-Term Ophthalmological Outcome
title_short Gamma Knife Radiosurgery for Indirect Dural Carotid–Cavernous Fistula: Long-Term Ophthalmological Outcome
title_sort gamma knife radiosurgery for indirect dural carotid–cavernous fistula: long-term ophthalmological outcome
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9410130/
https://www.ncbi.nlm.nih.gov/pubmed/36013354
http://dx.doi.org/10.3390/life12081175
work_keys_str_mv AT shenchiungchyi gammakniferadiosurgeryforindirectduralcarotidcavernousfistulalongtermophthalmologicaloutcome
AT tsueiyuangseng gammakniferadiosurgeryforindirectduralcarotidcavernousfistulalongtermophthalmologicaloutcome
AT yangmengyin gammakniferadiosurgeryforindirectduralcarotidcavernousfistulalongtermophthalmologicaloutcome
AT youweirchiang gammakniferadiosurgeryforindirectduralcarotidcavernousfistulalongtermophthalmologicaloutcome
AT sunminghis gammakniferadiosurgeryforindirectduralcarotidcavernousfistulalongtermophthalmologicaloutcome
AT sheumeeiling gammakniferadiosurgeryforindirectduralcarotidcavernousfistulalongtermophthalmologicaloutcome
AT panliangyi gammakniferadiosurgeryforindirectduralcarotidcavernousfistulalongtermophthalmologicaloutcome
AT sheehanjason gammakniferadiosurgeryforindirectduralcarotidcavernousfistulalongtermophthalmologicaloutcome
AT panhungchuan gammakniferadiosurgeryforindirectduralcarotidcavernousfistulalongtermophthalmologicaloutcome