The long-term results of the irradiation therapy for the dural arteriovenous malformation

Although radiotherapy has been used to treat non-neoplastic vascular diseases, it is not widely accepted as a standardized treatment for dural arteriovenous malformations (DAVM). The uncertainties regarding the therapeutic out-come and the benign nature of DAVM are the major factors that limit the indication of radiotherapy. In an attempt to assess the long-term benefits and risks of the treatment, we analyzed 24 patients with DAVM treated with radiotherapy. The cavernous sinuses were involved in 12 and the transverse-sigmoid sinuses in 12. Doses ranging from 10 to 56 Gy (median 44.9 Gy) were delivered by multiple fractionation. In terms of clinical improvement, complete response was achieved in 19 patients and partial response in five. Four patients had recurrence of symptoms; two patients were re-irradiated with the result of good symptomatic relief, one patient was successfully treated with transarterial embolization and the other patient with less disabling symptoms was managed conservatively. No adverse side effects attributed to radiation were encountered during the follow-up period of 0.5-17 years (median 8.5 years). Radiotherapy is a safe and effective method for the treatment of DAVM and is warranted in patients who are unsuitable for transarterial embolization or surgical procedure. (author)