{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,10]],"date-time":"2026-11-10T15:24:50Z","timestamp":1794324290546,"version":"4.9.0"},"reference-count":29,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,5]]},"abstract":"\n OBJECTIVE<\/jats:title>\n Clival epidural-osseous dural arteriovenous fistula (DAVF) is often associated with a large nidus, multiple arterial feeders, and complex venous drainage. In this study the authors report the outcomes of clival epidural-osseous DAVFs treated using Gamma Knife surgery (GKS).<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n \n Thirteen patients with 13 clival epidural-osseous DAVFs were treated with GKS at the authors\u2019 institution between 1993 and 2015. Patient age at the time of GKS ranged from 38 to 76 years (median 55 years). Eight DAVFs were classified as Cognard Type I, 4 as Type IIa, and 1 as Type IIa+b. The median treatment volume was 17.6 cm\n 3<\/jats:sup>\n (range 6.2\u201340.3 cm\n 3<\/jats:sup>\n ). The median prescribed margin dose was 16.5 Gy (range 15\u201318 Gy). Clinical and radiological follow-ups were performed at 6-month intervals. Patient outcomes after GKS were categorized as 1) complete improvement, 2) partial improvement, 3) stationary, and 4) progression.\n <\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n All 13 patients demonstrated symptomatic improvement, and on catheter angiography 12 of the 13 patients had complete obliteration and 1 patient had partial obliteration. The median follow-up period was 26 months (range 14\u2013186 months). The median latency period from GKS to obliteration was 21 months (range 8\u2013186 months). There was no intracranial hemorrhage during the follow-up period, and no deaths occurred. Two adverse events were observed following treatment, and 2 patients required repeat GKS treatment with eventual complete obliteration.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n Gamma Knife surgery offers a safe and effective primary or adjuvant treatment modality for complex clival epidural-osseous DAVFs. All patients in this case series demonstrated symptomatic improvement, and almost all patients attained complete obliteration.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2017.1.jns161346","type":"journal-article","created":{"date-parts":[[2017,6,16]],"date-time":"2017-06-16T09:59:46Z","timestamp":1497607186000},"page":"1364-1371","source":"Crossref","is-referenced-by-count":6,"title":["Gamma Knife surgery for clival epidural-osseous dural arteriovenous fistulas"],"prefix":"10.3171","volume":"128","author":[{"given":"Cheng-Chia","family":"Lee","sequence":"first","affiliation":[{"name":"Departments of Neurosurgery,"},{"name":"School of Medicine, National Yang-Ming University;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ching-Jen","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shao-Ching","family":"Chen","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huai-Che","family":"Yang","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery,"},{"name":"School of Medicine, National Yang-Ming University;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chung Jung","family":"Lin","sequence":"additional","affiliation":[{"name":"Radiology, and"},{"name":"School of Medicine, National Yang-Ming University;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chih-Chun","family":"Wu","sequence":"additional","affiliation":[{"name":"Radiology, and"},{"name":"School of Medicine, National Yang-Ming University;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wen-Yuh","family":"Chung","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery,"},{"name":"School of Medicine, National Yang-Ming University;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wan-Yuo","family":"Guo","sequence":"additional","affiliation":[{"name":"Radiology, and"},{"name":"School of Medicine, National Yang-Ming University;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Hung-Chi Pan","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery,"},{"name":"Taipei Medical University-Shuang Ho Hospital, Taipei, Taiwan; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cheng-Ying","family":"Shiau","sequence":"additional","affiliation":[{"name":"Radiation Oncology, Taipei Veterans General Hospital;"},{"name":"School of Medicine, National Yang-Ming University;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hsiu-Mei","family":"Wu","sequence":"additional","affiliation":[{"name":"Radiology, and"},{"name":"School of Medicine, National Yang-Ming University;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"839","DOI":"10.3171\/jns.1990.72.6.0839","article-title":"Intracranial dural arteriovenous malformations: factors predisposing to an aggressive neurological course","volume":"72","author":"Awad IA","year":"1990","unstructured":"Awad IA, Little JR, Akarawi WP, Ahl J: Intracranial dural arteriovenous malformations: factors predisposing to an aggressive neurological course. 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