• 제목/요약/키워드: Intracranial volume

검색결과 96건 처리시간 0.023초

두개인두종 : 소아와 성인에서 초기 증상과 연관된 종양의 특징 비교 (Craniopharyngioma : Comparison of Tumor Characteristics Relevant with Initial Symptomatology between Children and Adults)

  • 박동혁;박정율;김주한;정용구;이훈갑;이기찬;서중근
    • Journal of Korean Neurosurgical Society
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    • 제30권8호
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    • pp.985-991
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    • 2001
  • 목 적 : 두개인두종은 적어도 일부분이 상부 터어키안에 존재하는 양성종양이다. 그러나 이 종양으로 인한 증상과 징후는 종양의 위치뿐만 아니라 그 크기와 환자의 나이등에 영 향을 받는다고 알려져 있다. 이번 연구에서 본 저자들은 성인과 소아에서 증상과 연관된 두개인두종의 임상적 특징을 후향적으로 분석하였다. 방법 및 대상 : 1990년부터 1999년까지 두개인두종으로 치료를 받은 23명(성인 : 16명, 소아 : 7명)을 대상으로 종양의 크기, 성장양상과 주변조직으로의 침윤정도와 증상과의 연관성을 연구하였다. 분석을 위해 16명의 성인(남자 : 8명, 여자 : 8명, 평균연령 : 43.7세)과 7명의 소아(남자 : 5명, 여자 : 2명, 평균연령 : 10.1세)에게 MRI 및 CT를 시행하였으며 3차원적으로 종양의 부피를 측정하였다. 결 과 : 두개인두종에서 3대 주증상은 두개강 내압상승과 연관된 증상, 내분비 기능 이상, 시력이상이다. 종양의 크기는 소아군에서 성인군보다 컸으며 시력이상, 두개강 내압 상승과 연관된 증상, 뇌수두증도 소아군에서 더 많았다. 그러나 내분비 기능 이상과 시상하부와 시상, 뇌하수체, 전두엽과 다른 피질부위와 연결의 이상으로 인한 신경정신적과적인 증상은 성인군에서 더 많았다. 결 론 : 이번 연구에서 두개인두종은 종양의 크기와 침윤성은 두개강 내압 항진과 연관된 증상 및 시력 증상과 연관이 많으며 소아군에서 더 흔하게 나타났다. 하지만 종양의 성장 양상은 소아군과 성인군에서 주된 차이를 발견하지 못했다.

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감마나이프 방사선수술 치료계획의 평가에 필수불가결한 지표들의 분석 (Analyses of the indispensible Indices in Evaluating Gamma Knife Radiosurgery Treatment Plans)

  • 허병익
    • 한국방사선학회논문지
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    • 제11권5호
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    • pp.303-312
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    • 2017
  • 감마나이프 방사선수술(GKRS)의 핵심 목표는 병변에 처방 등선량 표면의 일치성을 최대화하고 병변 주변부 정상 조직의 방사선 효과를 최소화하는 것이다. 일치성 지표, 적용 범위, 선택성, 빔-온 시간, 기울기 지표(GI), 일치성/기울기 지표(CGI)와 같은 치료계획의 질과 관련된 다양한 종류의 지표들이 존재한다. 이 가운데 최상의 치료계획 평가 도구로서 우리는 일치성 지표, GI 및 CGI를 반드시 확인해야 한다. 특히 건강한 정상조직의 합병증과 관련된 GI 및 CGI는 일치성 지표보다 더욱더 중요하게 여겨진다. 그래서 저자는 치료계획 시스템 렉셀 감마플랜(LGP) 및 검증 방법 가변 타원체 모형화 기술(VEMT)을 사용하여 광범위하게 적용되고 있는 GI 뿐 만 아니고 CGI, 새로이 정의된 일치성/기울기 지표를 계산하고 통계적으로 분석하였다. 본 연구는 GKRS로 치료받은 두개 내 병변을 가진 10명의 환자를 대상으로 하였다. 저자는 단지네 인자들: 처방 등선량 체적, 최대 선량의 30% 이상 체적, 병변 체적, 처방 등선량 절반의 체적 만을 가지고 LGP와 VEMT를 이용해서 지표를 계산했다. 모든 데이터는 두 가지 다른 측정기법을 비교하는데 사용되는 통계적 방법인 Paired t-test로 분석되었다. 10명의 사례에서 LGP와 VEMT 사이에 GI의 통계적 유의성은 관찰되지 않았다. GI의 차이는 -0.14에서 0.01 사이의 범위였다. LGP와 VEMT의 두 가지 방법으로 계산된 새롭게 정의된 기울기 지표 또한 통계적으로 유의하지 않았다. 저자는 LGP와 VEMT 사이에 처방 등선량 체적에 대한 통계적 차이를 발견하지 못했다. 최상의 치료계획을 결정하기 위한 또 하나의 평가 지표인 CGI도 통계적으로 유의하지 않았고 CGI의 차이는 -4에서 3까지 이었다. 똑같이 GKRS에 적합하게 새로이 정의된 일치성/기울기 지표도 통계 분석을 통해서 치료계획 평가를 위한 훌륭한 측정 기준으로 여겨진다. 통계분석 결과 VEMT는 GKRS에서 최상의 치료계획을 평가하기 위해 GI, 새로운 기울기 지표, CGI 및 새로운 CGI를 고려했을 때 LGP와 우수한 일치를 보였다. 저자는 LGP 및 VEMT를 통해서 빠르고 쉬운 평가도구의 적용성으로 인하여 GI 뿐 만 아니라 CGI와 새로이 정의된 CGI가 널리 사용되기를 기대한다.

토끼 뇌종양 모델에서의 관류 CT 영상에 관한 연구 (Research on Perfusion CT in Rabbit Brain Tumor Model)

  • 하본철;곽병국;정지성;임청환;정홍량
    • 대한방사선기술학회지:방사선기술과학
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    • 제35권2호
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    • pp.165-172
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    • 2012
  • VX2 암종을 이식한 토끼 뇌종양 모델에서, perfusion CT(computed tomography, CT)를 이용하여 종양과 정상 뇌조직의 혈류 특성을 알아보고자 하였다. 체중 2.4~3.0kg(평균 2.6kg)의 토끼(New Zealand white rabbit) 수놈 9마리를 대상으로, 토끼 뇌에 VX2 세포 현탁액 $1{\times}10^7$ cells/ml, 0.1 ml을 이식하고 종양이 5mm 정도 크기로 자라면 perfusion CT를 시행 하였다. GE사의 AW(advantage windows workstation, version 4.2)로 종양의 용적과 perfusion 값을 산출 하였다. 뇌종양의 평균 용적은 $316{\pm}181mm^3$ 이었고, 가장 큰 종양은 497 $mm^3$, 가장 작은 종양은 195 $mm^3$ 이었 이식된 종양 모두 단일 결절형으로 만들어졌고, 두개강 내로 전이는 발견되지 않았다. perfusion CT에서 종양 중심부의 혈류량(cerebral blood volume, CBV)은 $74.40{\pm}9.63$ 이었고, 종양쪽 정상 뇌조직에서는 $16.08{\pm}0.64$ 이었으며, 종양 반대쪽 정상 뇌조직에서는 $15.24{\pm}3.23$이었다. 혈류 속도(cerebral blood flow, CBF)는 종양 중심부에서 $962.91{\pm}75.96$ 이였고, 종양쪽 정상 뇌조직에서는 $357.82{\pm}12.82$ 이었으며, 종양 반대쪽 정상 뇌조직에서는 $323.19{\pm}83.24$ 이었다. 평균 통과시간(mean transit time, MTT)은 종양 중심부에서 $4.37{\pm}0.19$ 이었고, 종양쪽 정상 뇌조직에서는 $3.02{\pm}0.41$ 이었으며, 종양 반대쪽 정상 뇌조직에서는 $2.86{\pm}0.22$ 이었다. 투과성 표면적(permeability surface, PS)은 종양 중심부에서 $47.23{\pm}25.45$ 이었고, 종양쪽 정상 뇌조직에서는 $14.54{\pm}1.60$ 이었으며, 종양 반대쪽 정상 뇌조직에서는 $6.81{\pm}4.20$이었다. 또한, 종양 중심부에서 최고치 도달 시간(time to peak, TTP)은 $19.33{\pm}0.42$ 이었고, 종양쪽 정상 뇌조직에서는 $16.43{\pm}1.72$ 이었으며, 종양 반대쪽 정상 뇌조직에서는 $15.14{\pm}0.88$이었지만 통계적으로 유의하지 않았다. PEI(positive enhancement integral, PEI)은 종양 중심부에서 $61.56{\pm}16.07$ 이었고, 종양쪽 정상 뇌조직에서는 $12.58{\pm}2.61$ 이었으며, 종양 반대쪽 정상 뇌조직에서는 $8.26{\pm}5.55$ 이었다. 최대 증가 기울기(maximum slope of increase, MSI)는 종양 중심부에서 $13.18{\pm}2.81$ 이었고, 종양쪽 정상 뇌조직에서는 $6.99{\pm}1.73$ 이었으며, 종양 반대쪽 정상 뇌조직에서는 $6.41{\pm}1.39$ 이었다. 최대 감소 기울기(maximum slope of decrease, MSD)는 종양 중심부에서 $4.02{\pm}1.37$ 이었고, 종양쪽 정상 뇌조직에서는 $4.66{\pm}0.83$ 이었으며, 종양 반대쪽 정상 뇌조직에서는 $6.47{\pm}1.53$ 으로 나타났다. 결과적으로 정위적(stereotactic)으로 이식된 종양은 단일 결절형으로 두개강 내에 전이가 없어 정상 조직과 종양 조직의 비교 연구에 적합하며, perfusion CT 에서 얻어진 매개 변수(parameter)들은 종양과 정상 조직의 혈관 관류 상태 차이를 잘 반영해 주었다.

Stereological and Morphometric Analysis of MRI Chiari Malformation Type-1

  • Alkoc, Ozan Alper;Songur, Ahmet;Eser, Olcay;Toktas, Muhsin;Gonul, Yucel;Esi, Ertap;Haktanir, Alpay
    • Journal of Korean Neurosurgical Society
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    • 제58권5호
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    • pp.454-461
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    • 2015
  • Objective : In this study, we aimed to investigate the underlying ethiological factors in chiari malformation (CM) type-I (CMI) via performing volumetric and morphometric length-angle measurements. Methods : A total of 66 individuals [33 patients (20-65 years) with CMI and 33 control subjects] were included in this study. In sagittal MR images, tonsillar herniation length and concurrent anomalies were evaluated. Supratentorial, infratentorial, and total intracranial volumes were measured using Cavalieri method. Various cranial distances and angles were used to evaluate the platybasia and posterior cranial fossa (PCF) development. Results : Tonsillar herniation length was measured $9.09{\pm}3.39mm$ below foramen magnum in CM group. Tonsillar herniation/concurrent syringomyelia, concavity/defect of clivus, herniation of bulbus and fourth ventricle, basilar invagination and craniovertebral junction abnormality rates were 30.3, 27, 18, 2, 3, and 3 percent, respectively. Absence of cisterna magna was encountered in 87.9% of the patients. Total, IT and ST volumes and distance between Chamberlain line and tip of dens axis, Klaus index, clivus length, distance between internal occipital protuberance and opisthion were significantly decreased in patient group. Also in patient group, it was found that Welcher basal angle/Boogard angle increased and tentorial slope angle decreased. Conclusion : Mean cranial volume and length-angle measurement values significantly decreased and there was a congenital abnormality association in nearly 81.5 percent of the CM cases. As a result, it was concluded that CM ethiology can be attributed to multifactorial causes. Moreover, congenital defects can also give rise to this condition.

Falx Meningiomas : Surgical Results and Lessons Learned from 68 Cases

  • Chung, Sang-Bong;Kim, Chae-Yong;Park, Chul-Kee;Kim, Dong-Gyu;Jung, Hee-Won
    • Journal of Korean Neurosurgical Society
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    • 제42권4호
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    • pp.276-280
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    • 2007
  • Objective : The purpose of this study was to review the characteristics of falcine meningioma retrospectively and to identify the parameters associated with tumor recurrence. Methods : The analysis included; age, sex, extent of resection, and radiologic and pathologic findings. Falcine meningiomas were classified by location as anterior, middle, or posterior as described for parasagittal meningiomas. Results : Of the 795 meningioma patients treated between 1990 and 2004 at the authors' institution, 68 patients with meningiomas arising from the falx underwent craniotomies. There were 22 male and 46 female patients (1:2.1). Mean age was 55 years and ranged from 14 to 77 years. Locations of falcine meningioma were; the anterior third in 33 cases, middle in 20, and posterior in 15. Mean tumor volume was 42 cc and ranged from 4 to 140 cc. In 58 of the 68 patients tumors were totally removed. Additional surgery for recurrence was performed in 6 patients over 15 years. Of these 6 patients, only two patients underwent gross total tumor resection at first operation; the other four underwent subtotal tumor resection. Based on pathologic reports, the largest tumor subtype was transitional. There were four patients with a high grade tumor-three atypical and one anaplastic meningioma. Of the 68 patients, 59 achieved a good outcome (no neurological deficit or recurrence), six had temporary complications, two suffered new permanent postoperative deficits, and the remaining one died due to severe brain swelling despite postoperative intensive care. Extent of surgical resection was found to be significantly related to tumor recurrence. Conclusion : Falcine meningioma accounted for 8.5% of intracranial meningiomas and the transitional meningioma was the most common subtype of falcine meningioma. Gross total resection of tumor was the single most important predictor of an improved surgical outcome.

Immediate Postoperative Epidural Hematomas Adjacent to the Craniotomy Site

  • Jeon, Jin-Soo;Chang, In-Bok;Cho, Byung-Moon;Lee, Ho-Kook;Hong, Seung-Koan;Oh, Sae-Moon
    • Journal of Korean Neurosurgical Society
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    • 제39권5호
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    • pp.335-339
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    • 2006
  • Objective : The authors present eight cases of immediate post-operative epidural hematomas[EDHs] adjacent to the craniotomy site, describe clinical details of them, and discuss their pathogenesis. Methods : Medical records of eight cases were retrospectively reviewed and their clinical data, operation records, and radiological findings analyzed. Any risk factors of the EDHs were searched. Results : In 5 of 8 cases, adjacent EDHs developed after craniotomies for the surgical removal of brain tumors. Three cases of adjacent EDHs developed after a pterional approach and neck clipping of a ruptured anterior communicating artery aneurysm, a ventriculoperitoneal shunt, and a craniotomy for a post-traumatic EDH, respectively. In all eight cases, brain computed tomography[CT] scans checked immediately or a few hours after the surgery, revealed large EDHs adjacent to the previous craniotomy site, but there was no EDH beneath the previous craniotomy flap. After emergent surgical removal of the EDHs, 7 cases demonstrated good clinical outcomes, with one case yielding a poor result. Conclusion : Rapid drainage of a large volume of cerebrospinal fluid or intra-operative severe brain collapse may separate the dura from the calvarium and cause postoperative EDH adjacent to the previous craniotomy site. A high-pressure suction drain left in the epidural space may contribute to the pathogenesis. After the craniotomy for brain tumors or intracranial aneurysms, when remarkable brain collapse occurs, an immediate postoperative brain CT is mandatory to detect and adequately manage such unexpected events as adjacent EDHs.

뇌종양의 방사선치료후 발생한 만성변화의 CT소견 (CT of Late Complication of Central Nervous System after Radiation Therapy of Brain Tumors)

  • 홍성언;조종희;안치열
    • Radiation Oncology Journal
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    • 제2권2호
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    • pp.287-297
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    • 1984
  • The normal intracranial structures are relatively resistant to therapeutic radiation, but may react adversely in a variety of ways, and the damage to nerve tissue may be slow in making its appearance, and once damage has occured the patient recovers slowly and incompletly. Therefore, it is important to consider the possibility of either recurrent tumor or late adverse effect in any patient who has had radiotherapy. The determination o( rnorphological/pathological correlation is very important to the therapeutic radiologist who uses CT scans to define a treatment volume, as well as to the clinician who wishes to explain the patient's clinical state in terms of regress, progression, persistence, or recurrence of tumor or radiation-induced edema or necrosis, The authors are obtained as following results ; 1. The field size(whole CNS, large, intermediate, small field) was variable according to the location and extension of tumor and histopathologic diagnosis, and the tatal tumor dose was 4,000 to 6,000 rads except one of recurred case of 9,100 rads. The duration of follow up CT scan was from 3 months to 5 year 10 months. 2, The histopathologic diagnosis of 9cases were glioblastoma multiforme(3 cases), pineal tumor (3), oligodendroglioma (1), cystic astrocytoma (1), pituitary adenoma (1) and their adverse effects after radiation therapy were brain atrophy (4 cases) , radiation necrosis(2), tumor recurrence with or without calcification (2), radiation·induced infarction (1). 3. The recurrent symptoms after radiation therapy of brain tumor were not always the results of regrowth of neoplasm, but may represent late change of irradiated brain. 4. It must be need that we always consider the accurate treatment planning and proper treatment method to reduce undesirable late adverse effects in treatment of brain tumors.

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Pre- and Post-Angioplasty Perfusion CT with Acetazolamide Challenge in Patients with Unilateral Cerebrovascular Stenotic Disease

  • You, Seung-Hoon;Jo, Sung-Min;Kim, Young-June;Lee, Jong-Hyeog;Jo, Kwang-Deog;Park, Woong-Sub
    • Journal of Korean Neurosurgical Society
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    • 제54권4호
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    • pp.280-288
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    • 2013
  • Objective : Perfusion computed tomography (PCT) has the ability to measure quantitative value and produce maps of mean transit time (MTT), cerebral blood flow (CBF), and cerebral blood volume (CBV). We assessed cerebral hemodynamics by using these parameters and acetazolamide (ACZ) challenge for pre- and post-procedural evaluation in patients with unilateral cerebrovascular stenotic disease. Methods : Thirty patients underwent pre-procedural PCT with ACZ challenge, and 24 patients (80%) was conducted follow up PCT after angioplasty with same protocol. The mean MTT, CBF, and CBV were measured and compared in both middle cerebral arterial (MCA) territories before and after ACZ challenge. Hemispheric ratio and percent change after ACZ challenge were calculated before and after angioplasty. Results : The mean stenosis rate was 76.6%. Significant increases in MTT (32.6%, p=0.000) and significant decreases in CBF (-14.2%, p=0.000) were found in stenotic side MCA territories. After ACZ challenge, there were significant changes in MTT (37.4%, p=0.000), CBF (-13.1%, p=0.000), and CBV (-10.5%, p=0.001) in pre-procedural perfusion study. However, no significant increases were found in MTT, or decreases in CBF and CBV in post-procedural study. There were no significant changes after ACZ challenge also. In addition, the degrees of these changes (before and after ACZ challenge) were highly correlated with the stenotic degrees in pre-procedural perfusion study. Conclusion : PCT with ACZ challenge appears to be a useful tool to assess the cerebral perfusion status especially in patients with unilateral symptomatic stenotic disease.

고혈압성(高血壓性) 뇌출혈(腦出血) 환자(患者)의 Brain-CT소견과 일상생활능력(ADL)평가를 통한 예후인자에 대한 고찰 (Study on Prognostic Factors using Computerized Tomographic Findings and Ability in daily Life(ADL) Evaluation in Patients with Hypertensive Intracerebral Hemorrhage)

  • 정승현;신길조;이원철
    • 대한한의학회지
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    • 제18권1호
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    • pp.87-100
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    • 1997
  • Clinical Observation was made on 29 cases of Hypertensive intracerebral hemorrhage patients in the ICU of In-Chon Oriental Medical Hosptital of Dongguk University from October in 1994 to June in 1996. The observation are ability in daily life(ADL) of patients by Location and Type of Hemorrhage, Amounts of Hematoma, Graeb's Score, Intraventricular Hemorrhage, States 4th Ventricle, Surrounding Edema around the Hematoma, Middle Line Shift, Age, Level of Consciousness. Pupillary Light Reflex and Treatment Modalities. Our conclusions on Prognostic Factors using Computerized Tomographic Findings and Ability in daily Life(ADL) Evaluation in patients with Hypertensive Intracerebral Hemorrhage Patients are as follows. A variety of prognostic factors that influence ADL5+6(%) were observed. 1. ADL5+6($\%$) of total cases was 34.9%. The prognosis were unfavorable when high Graeb score(P<0.05), dilated 4th ventricle(P<0.01), much surrounding edema around the hematoma (P<0.05), unilateral unreactive or both unreactive pupillary light reflex(P<0.05). 2. There was no difference of ADL5+6(%) in both hypertensive basal ganglionic and thalamic intracerebral hemorrhage. 3. The prognosis gets poorer as the volume of hematoma is more than 16cc. But there was no difference of ADL5+6(%) in each group. 4. The prognosis gets poorer in cases with IVH than without IVH. But there was no difference of ADL5+6(%) in each group. 5. The prognosis gets poorer as the middle line shift is more than 6mm. But there was no. difference of ADL5+6(%) in each group. 6. The prognosis gets poorer as the level of consciousness is more than drowsy. But there' was no difference of ADL5+6(%) in each group.

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Stereotactic Radiosurgery for Dural Arteriovenous Fistulas Involving the Transverse-Sigmoid Sinus : A Single Center Experience and Review of the Literatures

  • Baek, Hong-Gyu;Park, Seong-Hyun;Park, Ki-Su;Kang, Dong-Hun;Hwang, Jeong-Hyun;Hwang, Sung-Kyoo
    • Journal of Korean Neurosurgical Society
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    • 제62권4호
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    • pp.458-466
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    • 2019
  • Objective : We retrospectively assessed the efficacy of stereotactic radiosurgery (SRS) for dural arteriovenous fistulas (DAVFs) involving the transverse-sigmoid sinus and analyzed the angiographic and clinical results with our 8-year experience. Methods : Nine patients with intracranial DAVFs involving the transverse-sigmoid sinus underwent SRS using a Gamma $Knife^{(R)}$ (Elekta Inc., Atlanta, GA, USA) between 2009 and 2016. Five patients underwent SRS for residual DAVFs after embolization and four patients were treated with SRS alone. The median target volume was $1.9cm^3$ (range, 0.8-14.2) and the median radiation dose of the target was 17 Gy (range, 16-20). The median follow-up period was 37 months (range, 7-81). Results : Pulsating tinnitus (33%) was the most common symptom. DAVFs were completely obliterated in four patients (44%) and subtotally obliterated in five (56%). Six patients (67%) showed complete recovery of symptoms or signs, and three (33%) showed incomplete recovery. One patient experienced a recurrent seizure. Adverse radiation effects after SRS occurred in one patient (11%). The total obliteration rates after SRS were 16.7%, 37.5%, and 68.7% at 1, 2, and 3 years, respectively. The median interval from SRS to total obliteration of the fistula was 31 months (range, 12-38). The rates at which the symptoms started to improve were 40% at 1 month and 80% at 2 months after SRS. Symptoms started to improve at a median of 5 weeks after SRS (range, 3-21). Conclusion : SRS with or without embolization is a safe and effective treatment to relieve symptoms and obliterate DAVFs on the transverse-sigmoid sinus.