Journal of Korean Neurosurgical Society

  • 제57권2호
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  • Pages.127-130
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  • 2015
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  • 2005-3711(pISSN)
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  • 1598-7876(eISSN)
대한신경외과학회 (The Korean Neurosurgical Society)
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Paradoxical Exacerbation of Symptoms with Obstruction of the Venous Outflow after Gamma Knife Radiosurgery for Treatment of a Dural Arteriovenous Fistula of the Cavernous Sinus

  • Ko, Jun Kyeung (Department of Neurosurgery, Medical Research Institute, Pusan National University Hospital) ;
  • Cho, Won Ho (Department of Neurosurgery, Medical Research Institute, Pusan National University Hospital) ;
  • Lee, Tae Hong (Department of Diagnostic Radiology, Medical Research Institute, Pusan National University Hospital) ;
  • Choi, Chang Hwa (Department of Neurosurgery, Medical Research Institute, Pusan National University Hospital)
  • 투고 : 2014.04.21
  • 심사 : 2014.09.23
  • 발행 : 2015.02.28
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초록

A 59-year-old female presented with progressive right proptosis, chemosis and ocular pain. An imaging work-up including conventional catheter angiography showed a right-sided dural arteriovenous fistula of the cavernous sinus, which drained into the right superior petrosal sinus, right superior ophthalmic vein, and right inferior ophthalmic vein, and cortical venous reflux was seen via the right petrosal vein in the right posterior fossa. After failure of transvenous embolization, the patient underwent Gamma Knife radiosurgery (GKRS). At one month after GKRS, she developed increasing ocular pain and occipital headache. Repeat angiography showed partial obliteration of the fistula and loss of drainage via the superior and inferior ophthalmic veins with severe congestion, resulting in slow flow around the right cerebellar hemisphere. Prompt transarterial embolization relieved the patient's ocular symptoms and headache. We report on a case of paradoxical exacerbation of symptoms resulting from obstruction of the venous outflow after GKRS for treatment of a dural arteriovenous fistula of the cavernous sinus.

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참고문헌

  1. Barcia-Salorio JL, Soler F, Barcia JA, Hernandez G : Stereotactic radiosurgery for the treatment of low-flow carotid-cavernous fistulae : results in a series of 25 cases. Stereotact Funct Neurosurg 63 : 266-270, 1994 https://doi.org/10.1159/000100330
  2. Chiou HJ, Chou YH, Guo WY, Teng MM, Hsu CC, Tiu CM, et al. : Verifying complete obliteration of carotid artery-cavernous sinus fistula : role of color Doppler ultrasonography. J Ultrasound Med 17 : 289-295, 1998 https://doi.org/10.7863/jum.1998.17.5.289
  3. Choi BS, Park JW, Kim JL, Kim SY, Park YS, Kwon HJ, et al. : Treatment Strategy Based on Multimodal Management Outcome of Cavernous Sinus Dural Arteriovenous Fistula (CSDAVF). Neurointervention 6 : 6-12, 2011 https://doi.org/10.5469/neuroint.2011.6.1.6
  4. Dalyai RT, Ghobrial G, Chalouhi N, Dumont AS, Tjoumakaris S, Gonzalez LF, et al. : Radiosurgery for dural arterio-venous fistulas : a review. Clin Neurol Neurosurg 115 : 512-516, 2013 https://doi.org/10.1016/j.clineuro.2013.01.020
  5. Flickinger JC, Kondziolka D, Maitz AH, Lunsford LD : An analysis of the dose-response for arteriovenous malformation radiosurgery and other factors affecting obliteration. Radiother Oncol 63 : 347-354, 2002 https://doi.org/10.1016/S0167-8140(02)00103-2
  6. Ghobrial GM, Marchan E, Nair AK, Dumont AS, Tjoumakaris SI, Gonzalez LF, et al. : Dural arteriovenous fistulas : a review of the literature and a presentation of a single institution's experience. World Neurosurg 80 : 94-102, 2013 https://doi.org/10.1016/j.wneu.2012.01.053
  7. Jung HH, Chang JH, Whang K, Pyen JS, Chang JW, Park YG : Gamma Knife surgery for low-flow cavernous sinus dural arteriovenous fistulas. J Neurosurg 113 Suppl : 21-27, 2010
  8. Kida Y : Radiosurgery for dural arteriovenous fistula. Prog Neurol Surg 22 : 38-44, 2009
  9. Korkmazer B, Kocak B, Tureci E, Islak C, Kocer N, Kizilkilic O : Endovascular treatment of carotid cavernous sinus fistula : a systematic review. World J Radiol 5 : 143-155, 2013 https://doi.org/10.4329/wjr.v5.i4.143
  10. Lau LI, Wu HM, Wang AG, Yen MY, Hsu WM : Paradoxical worsening with superior ophthalmic vein thrombosis after gamma knife radiosurgery for dural arteriovenous fistula of cavernous sinus : a case report suggesting the mechanism of the phenomenon. Eye (Lond) 20 : 1426-1428, 2006
  11. Loumiotis I, Lanzino G, Daniels D, Sheehan J, Link M : Radiosurgery for intracranial dural arteriovenous fistulas (DAVFs) : a review. Neurosurg Rev 34 : 305-315; discussion 315, 2011 https://doi.org/10.1007/s10143-011-0315-8
  12. O'Leary S, Hodgson TJ, Coley SC, Kemeny AA, Radatz MW : Intracranial dural arteriovenous malformations : results of stereotactic radiosurgery in 17 patients. Clin Oncol (R Coll Radiol) 14 : 97-102, 2002 https://doi.org/10.1053/clon.2002.0072
  13. Onizuka M, Mori K, Takahashi N, Kawahara I, Hiu T, Toda K, et al. : Gamma knife surgery for the treatment of spontaneous dural carotid-cavernous fistulas. Neurol Med Chir (Tokyo) 43 : 477-482; discussion 482-483, 2003 https://doi.org/10.2176/nmc.43.477
  14. Pan HC, Sun MH, Yang DY, Wang YC, Lee SD, Chen WH, et al. : Multidisciplinary treatment of cavernous sinus dural arteriovenous fistulae with radiosurgery and embolization. J Clin Neurosci 12 : 744-749, 2005 https://doi.org/10.1016/j.jocn.2004.09.026
  15. Pollock BE, Nichols DA, Garrity JA, Gorman DA, Stafford SL : Stereotactic radiosurgery and particulate embolization for cavernous sinus dural arteriovenous fistulae. Neurosurgery 45 : 459-466; discussion 466-467, 1999 https://doi.org/10.1097/00006123-199909000-00008
  16. Soderman M, Edner G, Ericson K, Karlsson B, Rahn T, Ulfarsson E, et al. : Gamma knife surgery for dural arteriovenous shunts : 25 years of experience. J Neurosurg 104 : 867-875, 2006 https://doi.org/10.3171/jns.2006.104.6.867
  17. Wu HM, Pan DH, Chung WY, Guo WY, Liu KD, Shiau CY, et al. : Gamma Knife surgery for the management of intracranial dural arteriovenous fistulas. J Neurosurg 105 Suppl : 43-51, 2006