1.A Practical Grading Scale for Predicting Outcomes of Radiosurgery for Dural Arteriovenous Fistulas: JLGK 1802 Study
Hirotaka HASEGAWA ; Masahiro SHIN ; Jun KAWAGISHI ; Hidefumi JOKURA ; Toshinori HASEGAWA ; Takenori KATO ; Mariko KAWASHIMA ; Yuki SHINYA ; Hiroyuki KENAI ; Takuya KAWABE ; Manabu SATO ; Toru SERIZAWA ; Osamu NAGANO ; Kyoko AOYAGI ; Takeshi KONDOH ; Masaaki YAMAMOTO ; Shinji ONOUE ; Kiyoshi NAKAZAKI ; Yoshiyasu IWAI ; Kazuhiro YAMANAKA ; Seiko HASEGAWA ; Kosuke KASHIWABARA ; Nobuhito SAITO ;
Journal of Stroke 2022;24(2):278-287
Background:
and Purpose To assess the long-term outcomes of intracranial dural arteriovenous fistula (DAVF) treated with stereotactic radiosurgery (SRS) alone or embolization and SRS (Emb-SRS) and to develop a grading system for predicting DAVF obliteration.
Methods:
This multi-institutional retrospective study included 200 patients with DAVF treated with SRS or Emb-SRS. We investigated the long-term obliteration rate and obliteration-associated factors. We developed a new grading system to estimate the obliteration rate. Additionally, we compared the outcomes of SRS and Emb-SRS by using propensity score matching.
Results:
The 3- and 4-year obliteration rates were 66.3% and 78.8%, respectively. The post-SRS hemorrhage rate was 2%. In the matched cohort, the SRS and Emb-SRS groups did not differ in the rates of obliteration (P=0.54) or post-SRS hemorrhage (P=0.50). In multivariable analysis, DAVF location and cortical venous reflux (CVR) were independently associated with obliteration. The new grading system assigned 2, 1, and 0 points to DAVFs in the anterior skull base or middle fossa, DAVFs with CVR or DAVFs in the superior sagittal sinus or tentorium, and DAVFs without these factors, respectively. Using the total points, patients were stratified into the highest (0 points), intermediate (1 point), or lowest (≥2 points) obliteration rate groups that exhibited 4-year obliteration rates of 94.4%, 71.3%, and 60.4%, respectively (P<0.01).
Conclusions
SRS-based therapy achieved DAVF obliteration in more than three-quarters of the patients at 4 years of age. Our grading system can stratify the obliteration rate and may guide physicians in treatment selection.
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