Dural carotid cavernous fistulas: role of conventional radiation therapy--long-term results with irradiation, embolization, or both

• Published in: Radiology Vol. 207; no. 2; p. 423
• Main Authors: Hirai, T, Korogi, Y, Baba, Y, Nishimura, R, Hamatake, S, Kawanaka, K, Bussaka, H, Takahashi, M
• Format: Journal Article
• Language: English
• Published: United States 01.05.1998
• Subjects: Adult; Aged; Angiography, Digital Subtraction; Arteriovenous Fistula - radiotherapy; Arteriovenous Fistula - therapy; Blood Flow Velocity - physiology; Carotid Arteries - abnormalities; Cavernous Sinus - abnormalities; Clinical Protocols; Combined Modality Therapy; Contrast Media; Dura Mater - blood supply; Embolization, Therapeutic - instrumentation; Embolization, Therapeutic - methods; Evaluation Studies as Topic; Female; Follow-Up Studies; Humans; Longitudinal Studies; Male; Middle Aged; Radiotherapy Dosage; Regional Blood Flow - physiology; Stereotaxic Techniques
• ISSN: 0033-8419; 1527-1315
• DOI: 10.1148/radiology.207.2.9577491

To evaluate the long-term results of irradiation alone or of embolization with or without irradiation in patients with dural carotid cavernous fistulas (DCCFs). Between 1984 and 1996, symptomatic DCCFs in 26 patients were treated by using irradiation alone (protocol 1, n = 12) before April 1988 and by using embolization as an initial treatment (protocol 2, n = 14) during and after April 1988. When angiography showed no improvement after embolization, irradiation was added (n = 6). On the basis of drainage flow speed, DCCFs were classified as fast, medium, or slow. With irradiation alone, all six patients with slow- to medium-type DCCFs had cure with a mean follow-up of 62 months. Four of six patients with fast-type DCCFs had cure or improvement, but the remaining two had no change. In the embolization group, irradiation was added in six patients with fast-type DCCFs. With a mean follow-up of 24 months, four of the six patients had cures, one had improvement, and one had no clinical change. Those who underwent protocol 2 had cures significantly earlier than those who underwent protocol 1 (P < .05). Conventional radiation therapy resulted in cure of DCCFs in nine (75%) of the 12 patients and in improvement of signs and symptoms in one (8%). Fast-type DCCFs may not always be improved. Radiation therapy may be useful in DCCFs after embolization.