Radiology, Vol 207, 423-430, Copyright © 1998 by Radiological Society of North America
Dural carotid cavernous fistulas: role of conventional radiation therapy--long-term results with irradiation, embolization, or both
T Hirai, Y Korogi, Y Baba, R Nishimura, S Hamatake, K Kawanaka, H Bussaka and M Takahashi
Department of Radiology, Kumamoto University School of Medicine, Japan.
PURPOSE: To evaluate the long-term results of irradiation alone or of
embolization with or without irradiation in patients with dural carotid
cavernous fistulas (DCCFs). MATERIALS AND METHODS: 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. RESULTS: 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).
CONCLUSION: 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.
