{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,8]],"date-time":"2026-02-08T08:10:58Z","timestamp":1770538258007,"version":"3.49.0"},"reference-count":40,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"Special_Supplement","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JNS"],"published-print":{"date-parts":[[2010,12]]},"abstract":"<jats:sec>\n<jats:title>Object<\/jats:title>\n<jats:p>In the modern era, stereotactic radiosurgery is an important part of the multidisciplinary and multimodality approach used to treat dural carotid-cavernous fistulas (DCCFs). Based on the ease of performance of techniques to fuse cerebral angiography studies with MR images or CT scans during the radiosurgical procedure, the Gamma Knife and XKnife are 2 of the most popular radiosurgical instruments for patients with DCCF. In this study, the authors compared the efficacy, neurological results, and complications associated with these 2 radiosurgical devices when used for DCCF.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>Records for 41 patients with DCCF (15 treated using the XKnife and 26 with Gamma Knife surgery [GKS]) were retrieved from a radiosurgical database encompassing the period of September 2000 to August 2008. Among these patients, at least 2 consecutive MR imaging or MR angiography studies obtained after radiosurgery were available for determining radiological outcome of the fistula. All patients received regular follow-up to evaluate the neurological and ophthalmological function at an interval of 1\u20133 months. The symptomatology, obliteration rate, radiation dose, instrument accuracy, and adverse effects were determined for each group and compared between 2 groups. The data were analyzed using the Student t-test.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>The mean age of the patients was 63 \u00b1 2.6 years, and the mean follow-up period was 63.1 \u00b1 4.4 months (mean \u00b1 SD). Thirty-seven patients (90%) achieved an obliteration of the DCCF (93% in the XKnife cohort and 88% for the GKS cohort). In 34 of 40 patients (85%) with chemosis and proptosis of the eyes, these symptoms were resolved after treatment (4 had residual fistula and 2 had arterializations of sclera). All 5 patients with high intraocular pressure demonstrated clinical improvement. Ten (71%) of 14 patients with cranial nerve palsy demonstrated improvement following radiosurgery. Significant discrepancies of treatment modalities existed between the XKnife and GKS groups, such as radiation volume, conformity index, number of isocenters, instrument accuracy, peripheral isodose line, and maximum dosage. The XKnife delivered significantly higher radiation dosage to the lens, optic nerve, optic chiasm, bilateral temporal lobe, and brainstem. Few adverse events occurred, but included 1 patient with optic neuritis (GKS group), 1 intracranial hemorrhage (XKnife group), 1 brainstem edema (XKnife), and 3 temporal lobe radiation edemas (XKnife).<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Radiosurgery affords a substantial chance of radiological and clinical improvement in patients with DCCFs. The Gamma Knife and XKnife demonstrated similar efficacy in the obliteration of DCCFs. However, a slightly higher incidence of complications occurred in the XKnife group.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2010.8.gks10689","type":"journal-article","created":{"date-parts":[[2018,11,16]],"date-time":"2018-11-16T01:09:47Z","timestamp":1542330587000},"page":"9-20","source":"Crossref","is-referenced-by-count":14,"title":["Radiosurgery for dural carotid-cavernous sinus fistulas: Gamma Knife compared with XKnife radiosurgery"],"prefix":"10.3171","volume":"113","author":[{"given":"Hung-Chuan","family":"Pan","sequence":"first","affiliation":[{"name":"Departments of Neurosurgery and"},{"name":"Institute of Biomedical Sciences, National Chung-Hsing University, Taichung;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ming-Hsi","family":"Sun","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jason","family":"Sheehan","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Meei-Ling","family":"Sheu","sequence":"additional","affiliation":[{"name":"Institute of Biomedical Sciences, National Chung-Hsing University, Taichung;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Clayton Chi-Chang","family":"Chen","sequence":"additional","affiliation":[{"name":"Neuroradiology, Taichung Veterans General Hospital;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hsu-Tung","family":"Lee","sequence":"additional","affiliation":[{"name":"Neuroradiology, Taichung Veterans General Hospital;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wen-Ta","family":"Chiu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Taipei Medical University-Shunag Ho Hospital, Taipei;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dar-Yu","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Chang Bing Show Chwan Memorial Hospital, Changhua, Taiwan; and"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"b1-1130009","series-title":"Br J Neurosurg","first-page":"228","article-title":"Endovascular approach to treatment of indirect caroticocavernous fistulae","volume":"15","author":"Annesley-Williams","year":"2001"},{"key":"b2-1130009","series-title":"Stereotact Funct Neurosurg","first-page":"266","article-title":"Stereotactic radiosurgery for the treatment of low-flow carotid-cavernous fistulae: results in a series of 25 cases","volume":"63","author":"Barcia-Salorio","year":"1994"},{"key":"b3-1130009","series-title":"J Neurosurg","first-page":"248","article-title":"Classification and treatment of spontaneous carotid-cavernous sinus fistulas","volume":"62","author":"Barrow","year":"1985"},{"key":"b4-1130009","series-title":"Radiology","first-page":"265","article-title":"Suspected dural arteriovenous fistula: results with screening MR angiography in seven patients","volume":"183","author":"Chen","year":"1992"},{"key":"b5-1130009","series-title":"Radiology","first-page":"671","article-title":"Cerebral dural arteriovenous fistulas: clinical and angiographic correlation with a revised classification of venous drainage","volume":"194","author":"Cognard","year":"1995"},{"key":"b6-1130009","series-title":"Int J Radiat Oncol Biol Phys","first-page":"951","article-title":"A simple method to verify in vivo the accuracy of target coordinates in linear accelerator radiosurgery","volume":"41","author":"Colombo","year":"1998"},{"key":"b7-1130009","series-title":"Neurosurgery","first-page":"1119","article-title":"Direct microsurgery of dural arteriovenous malformation type carotid-cavernous sinus fistulas: indications, technique, and results","volume":"41","author":"Day","year":"1997"},{"key":"b8-1130009","series-title":"Interventional Neuroradiology","first-page":"23","article-title":"Endovascular management of carotid cavernous fistulas","author":"Debrun","year":"1993"},{"key":"b9-1130009","series-title":"Int J Radiat Oncol Biol Phys","first-page":"485","article-title":"Complications from arteriovenous malformation radiosurgery: multivariate analysis and risk modeling","volume":"38","author":"Flickinger","year":"1997"},{"key":"b10-1130009","series-title":"The Cavernous Sinus: A Comprehensive Text","first-page":"209","article-title":"Endovascular techniques in the treatment of carotid cavernous fistulas","author":"Gobin","year":"2000"},{"key":"b11-1130009","series-title":"J Neurosurg","first-page":"289","article-title":"Combining endovascular and neurosurgical treatments of high-risk dural arteriovenous fistulas in the lateral sinus and the confluence of the sinuses","volume":"90","author":"Goto","year":"1999"},{"key":"b12-1130009","series-title":"AJNR Am J Neuroradiol","first-page":"1081","article-title":"Radiosurgery as a treatment alternative for dural arteriovenous fistulas of the cavernous sinus","volume":"19","author":"Guo","year":"1998"},{"key":"b13-1130009","series-title":"Acta Radiol Suppl","first-page":"580","article-title":"Closure of carotid cavernous sinus fistulae by external compression of the carotid artery and jugular vein","volume":"369","author":"Higashida","year":"1986"},{"key":"b14-1130009","series-title":"AJNR Am J Neuroradiol","first-page":"253","article-title":"Three-dimensional FISP imaging in the evaluation of carotid cavernous fistula: comparison with contrast-enhanced CT and spin-echo MR","volume":"19","author":"Hirai","year":"1998"},{"key":"b15-1130009","series-title":"Neuroradiology","first-page":"67","article-title":"Intracerebral hemorrhage in carotid-cavernous 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fistula","volume":"52","author":"Komiyama","year":"1999"},{"key":"b20-1130009","series-title":"Acta Neurochir (Wien)","first-page":"1101","article-title":"The costs of radiosurgical treatment: comparison between gamma knife and linear accelerator","volume":"140","author":"K\u00f6nigsmaier","year":"1998"},{"issue":"3 Suppl","key":"b21-1130009","series-title":"Neurosurgery","first-page":"130","article-title":"The Leksell Gamma Knife Perfexion and comparisons with its predecessors","volume":"61","author":"Lindquist","year":"2007"},{"key":"b22-1130009","series-title":"J Neurosurg","first-page":"804","article-title":"The role of radiosurgery and particulate embolization in the treatment of dural arteriovenous fistulas","volume":"84","author":"Link","year":"1996"},{"key":"b23-1130009","series-title":"Int J Radiat Oncol Biol Phys","first-page":"1465","article-title":"Quality assurance for gamma knife stereotactic 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Case report","volume":"92","author":"Ohtakara","year":"2000"},{"key":"b28-1130009","series-title":"Neurol Med Chir (Tokyo)","first-page":"477","article-title":"Gamma knife surgery for the treatment of spontaneous dural carotid-cavernous fistulas","volume":"43","author":"Onizuka","year":"2003"},{"key":"b29-1130009","series-title":"AJNR Am J Neuroradiol","first-page":"1476","article-title":"Cavernous sinus and inferior petrosal sinus flow signal on three-dimensional time-of-flight MR angiography","volume":"20","author":"Ouanounou","year":"1999"},{"issue":"Suppl","key":"b30-1130009","series-title":"J Neurosurg","first-page":"124","article-title":"Late cyst formation following gamma knife surgery of arteriovenous malformations","volume":"102","author":"Pan","year":"2005"},{"key":"b31-1130009","series-title":"J Clin Neurosci","first-page":"744","article-title":"Multidisciplinary treatment of cavernous sinus dural arteriovenous fistulae with radiosurgery and embolization","volume":"12","author":"Pan","year":"2005"},{"key":"b32-1130009","series-title":"Neurosurgery","first-page":"1133","article-title":"The role of transvenous embolization in the treatment of intracranial dural arteriovenous fistulas","volume":"40","author":"Roy","year":"1997"},{"key":"b33-1130009","series-title":"Ophthalmology","first-page":"205","article-title":"The syndrome of paradoxical worsening of dural-cavernous sinus arteriovenous malformations","volume":"94","author":"Sergott","year":"1987"},{"key":"b34-1130009","series-title":"Phys Med Biol","first-page":"887","article-title":"Dosimetry of Gamma Knife and linac-based radiosurgery using radiochromic and diode detectors","volume":"44","author":"Somigliana","year":"1999"},{"key":"b35-1130009","series-title":"J Neurosurg","first-page":"647","article-title":"Microsurgery and radiosurgery in brain arteriovenous malformations","volume":"79","author":"Steiner","year":"1993"},{"key":"b36-1130009","series-title":"AJNR Am J Neuroradiol","first-page":"886","article-title":"Dural arteriovenous fistula of the cavernous sinus with venous congestion of the brain stem: report of two cases","volume":"20","author":"Takahashi","year":"1999"},{"key":"b37-1130009","series-title":"J Neurol Neurosurg Psychiatry","first-page":"174","article-title":"Diagnosis and treatment of dural carotid-cavernous fistulas: a consecutive series of 27 patients","volume":"78","author":"Th\u00e9audin","year":"2007"},{"key":"b38-1130009","series-title":"J Neurosurg","first-page":"976","article-title":"Spontaneous carotid-cavernous fistulas: clinical, radiological, and therapeutic considerations. Experience with 20 cases","volume":"60","author":"Vi\u00f1uela","year":"1984"},{"key":"b39-1130009","series-title":"AJNR Am J Neuroradiol","first-page":"651","article-title":"Transvenous embolization of dural carotid cavernous fistulas: a series of 44 consecutive patients","volume":"31","author":"Yoshida","year":"2010"},{"key":"b40-1130009","series-title":"J Appl Clin Med Phys","first-page":"28","article-title":"Quality assurance of beam accuracy for Leksell Gamma Unit","volume":"1","author":"Yu","year":"2000"}],"container-title":["Journal of Neurosurgery"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/113\/Special_Supplement\/article-p9.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/113\/Special_Supplement\/article-p9.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/113\/Special_Supplement\/article-p9.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,3,27]],"date-time":"2023-03-27T04:00:52Z","timestamp":1679889652000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/113\/Special_Supplement\/article-p9.xml"}},"subtitle":["Clinical article"],"short-title":[],"issued":{"date-parts":[[2010,12]]},"references-count":40,"journal-issue":{"issue":"Special_Supplement"},"URL":"https:\/\/doi.org\/10.3171\/2010.8.gks10689","relation":{},"ISSN":["0022-3085","1933-0693"],"issn-type":[{"value":"0022-3085","type":"print"},{"value":"1933-0693","type":"electronic"}],"subject":[],"published":{"date-parts":[[2010,12]]}}}