efficacy and safety of radiosurgery in patients with intracranial dural arteriovenous fistulae
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EBS presentation 1
“ Efficacy and safety of radiosurgery in patients with intracranial dural arteriovenous fistulae”
Santhosh George Thomas
Evidence Based Surgery presentation
11/08/2014
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Background
• 41 year old doctor diagnosed to have a right transverse sigmoid junction dural AV fistula
• Options of treatment explained • Question of efficacy of SRS
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Searchable question (PICO format)
• P – Patients with intracranial dural av fistulae,• I – Radiosurgery• C - • O –Safety and efficacy
Question:
What is the efficacy and safety of radiosurgery in patients with intracranial dural arteriovenous fistulae?
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Search strategy
• Ovid Medline• Embase• Scopus• Cochrane Reviews
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Medline
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Embase
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PRISMA flow diagramEmbase 65Medline 43
After duplicates removed in end note, 165 articles
13 articles for review
- Not relevant after title and/ or abstract screening-Excluded case reports/reviews/letter to the editor (4)- Excluded 4 articles by the same group from 2002-2013
Scopus 98Cochrane 0
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Summary of papers
• Only 13 studies with reqd data (N=821)
with Cortical venous drainage (N=299, ~37% of the total)
• 4 were prospective and 9 retrospective• 3 Linac systems and 10 GKS
• Mean and 95% CI calculated using the modified Wald’s method
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ClinicalPresentation
Mean (%) 95% CI Lower limit
95% CI Upper limit
Tinnitus/Bruit 42.57% 35.96 49.47
Hemorrhage 26.24 % 20.64 32.72
Chemosis/headache
21.29 % 16.18 27.47
Neurological Deficit
4.95% 2.6 8.98
Acute Hydrocephalus
1.98% 0.59 5.16
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• Previous Craniotomy in 5.22% (95% CI 3.68-7.64)
• Previous / Immediate post SRS embolisation in 28.79% (95% CI 25.29 -32.56)
• Mean follow up 40.72 months
• Mean prescribed dose was 19.7 GY
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64.62%
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4.51% (Hemorrhage/ Radiation necrosis/ Neurological deficit)
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• Mortality was 0.24% (only 2 cases, 95% CI 0.01-0.94)
• ~37% of the group had CVD
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Conclusions
• Difficult condition to treat effectively• Though a total of ~33% pts had received
some previous modality of treatment, the three and half year complete obliteration rate was only 64%
• This came with a morbidity of ~4.5%• May not suitable as a first line treatment
strategy• Not very effective in fistulae with CVD
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