Linear accelerator-based radiosurgery in treating indirect carotid cavernous fistulas

Abstract

Introduction: The purpose of this study is to determine the success and complication rates of linear accelerator (LINAC)-based radiosurgery (X-knife) for indirect carotid-cavernous fistulas (CCFs). Materials and Methods: This retrospective study was performed at the Department of Radiosurgery, Chang Gung Memorial Hospital, Taiwan, and reviewed data from May 2006 to May 2018. Thirteen patients with CCF who were treated with stereotactic radiosurgery were included, and side, volume, pathological type, origin, location, postoperative regression, and recurrence rate were evaluated with postradiotherapy. Patients were either followed up with contrast magnetic resonance imaging or angiography. Radiosurgery was considered successful if the patients' clinical symptoms improved with radiological remission or if there was a reduction in CCF flow in angiography. Results: Of the 11 patients, three (27.3%) received transarterial embolization (TAE) before radiosurgery. Successful radiological outcomes were seen in 10 (90.9%) patients, and the remaining one patient (9.1%) had stationary disease with no reduction in CCF flow. Ten patients (90.9%) had improved clinical symptoms; however, one patient (9.1%) was complicated with iatrogenic blindness after TAE treatment. No acute or subacute transient postradiation changes, optic nerve injuries, or brainstem radionecrosis were noted in any of the patients. Conclusions: In this study, LINAC-based radiosurgery for CCF was found to be an effective, safe, and successful treatment alternative to TAE treatment in patients with indirect CCF. The risk of postradiotherapy complications was low, and obliteration and regression rates were high.

Keywords

• carotid-cavernous sinus fistula
• dural
• stereotactic radiosurgery
• x-knife