{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T03:12:08Z","timestamp":1760238728169,"version":"build-2065373602"},"reference-count":48,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2022,8,1]],"date-time":"2022-08-01T00:00:00Z","timestamp":1659312000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Taichung Veterans General Hospital","award":["TCVGH-PU1088103","TCVGH-1117303C","TCVGH-1117303D"],"award-info":[{"award-number":["TCVGH-PU1088103","TCVGH-1117303C","TCVGH-1117303D"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>Objective: The leading treatment option for dural carotid\u2013cavernous sinus fistula is an endovascular approach with immediate improvement. Alternatively, radiosurgery is a slow response for obliterating the fistula and poses a radiation risk to the optic apparatus and the associated cranial nerves and blood vessels. In this study, we retrieved cases from a prospective database to assess the ophthalmological outcomes and complications in treating dural carotid cavernous sinus fistula with gamma knife radiosurgery (GKRS). Material and Methods: We retrieved a total of 65 cases of carotid cavernous sinus fistula treated with GKRS with margin dose of 18\u201320 Gy from 2003 to 2018 and reviewed the ophthalmological records required for our assessment. Results: The mean target volume was 2 \u00b1 1.43 cc. The onset of symptom alleviated after GKRS was 3.71 \u00b1 7.68 months. There were two cases with residual chemosis, two with cataract, two with infarction, one with transient optic neuropathy, and four with residual cranial nerve palsy, but none with glaucoma or dry eyes. In MRA analysis, total obliteration of the fistula was noted in 64 cases with no detectable ICA stenosis nor cavernous sinus thrombosis. In the Cox regression analysis, post-GKRS residual cranial nerve palsy was highly correlated to targeted volume (p &lt; 0.05) and age (p &lt; 0.05). The occurrence of post-GKRS cataract was related to the initial symptom of chemosis (p &lt; 0.05). Conclusion: GKRS for carotid cavernous sinus fistula offers a high obliteration rate and preserves the cavernous sinus vascular structure while conferring a low risk of treatment complications such as adverse radiation risk to the optic apparatus and adjacent cranial nerves.<\/jats:p>","DOI":"10.3390\/life12081175","type":"journal-article","created":{"date-parts":[[2022,8,1]],"date-time":"2022-08-01T21:01:24Z","timestamp":1659387684000},"page":"1175","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Gamma Knife Radiosurgery for Indirect Dural Carotid\u2013Cavernous Fistula: Long-Term Ophthalmological Outcome"],"prefix":"10.3390","volume":"12","author":[{"given":"Chiung-Chyi","family":"Shen","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Taichung Veterans General Hospital, Taichung 40201, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuang-Seng","family":"Tsuei","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Taichung Veterans General Hospital, Taichung 40201, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Meng-Yin","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Taichung Veterans General Hospital, Taichung 40201, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Weir-Chiang","family":"You","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Taichung Veterans General Hospital, Taichung 40201, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ming-His","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Taichung Veterans General Hospital, Taichung 40201, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0431-1282","authenticated-orcid":false,"given":"Meei-Ling","family":"Sheu","sequence":"additional","affiliation":[{"name":"Institute of Biomedical Science, National Chun-Hsin University, Taichung 402, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Liang-Yi","family":"Pan","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jason","family":"Sheehan","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Virginia, Charlottesville, VA 22908, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3021-7676","authenticated-orcid":false,"given":"Hung-Chuan","family":"Pan","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Taichung Veterans General Hospital, Taichung 40201, Taiwan"},{"name":"PhD Program in Translation Medicine, Rong Hsing Research Center for Translation Medicine, National Chun-Hsin University, Taichung 402, Taiwan"},{"name":"Department of Medical Research, Taichung Veterans General Hospital, Taichung 40201, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,8,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"248","DOI":"10.3171\/jns.1985.62.2.0248","article-title":"Classification and Treatment of Spontaneous Carotid-Cavernous Sinus Fistulas","volume":"62","author":"Barrow","year":"1985","journal-title":"J. Neurosurg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"671","DOI":"10.1148\/radiology.194.3.7862961","article-title":"Cerebral Dural Arteriovenous Fistulas: Clinical and Angiographic Correlation with a Revised Classification of Venous Drainage","volume":"194","author":"Cognard","year":"1995","journal-title":"Radiology"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1097\/WNO.0b013e3181989fc0","article-title":"Endovascular Techniques for Treatment of Carotid-Cavernous Fistula","volume":"29","author":"Gemmete","year":"2009","journal-title":"J. Neuro. Ophthalmol. Off. J. N. Am. Neuro.Ophthalmol. Soc."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1055\/s-0029-1242801","article-title":"Minimally Invasive Approaches to Treating Chemosis of the Eyes from Unusual Dural Arteriovenous Fistulae","volume":"52","author":"Pan","year":"2009","journal-title":"Minim. Invasive Neurosurg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"9","DOI":"10.3171\/2010.8.GKS10689","article-title":"Radiosurgery for Dural Carotid-Cavernous Sinus Fistulas: Gamma Knife Compared with Xknife Radiosurgery","volume":"113","author":"Pan","year":"2010","journal-title":"J. Neurosurg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"486","DOI":"10.1007\/s00234-006-0089-9","article-title":"Endovascular Management of Dural Carotid-Cavernous Sinus Fistulas in 141 Patients","volume":"48","author":"Kirsch","year":"2006","journal-title":"Neuroradiology"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1136\/jnnp.2006.100776","article-title":"Diagnosis and Treatment of Dural Carotid-Cavernous Fistulas: A Consecutive Series of 27 Patients","volume":"78","author":"Chapot","year":"2007","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1007\/s00701-002-1013-7","article-title":"Transvenous Embolisation of Dural Carotid-Cavernous Fistulas by Multiple Venous Routes: A Series of 27 Cases","volume":"145","author":"Cheng","year":"2003","journal-title":"Acta Neurochir."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"983","DOI":"10.1007\/s00234-010-0805-3","article-title":"Clinical and Angiographic Factors Related to the Prognosis of Cavernous Sinus Dural Arteriovenous Fistula","volume":"53","author":"Jung","year":"2011","journal-title":"Neuroradiology"},{"key":"ref_10","first-page":"2078","article-title":"Results of Transvenous Embolization of Cavernous Dural Arteriovenous Fistula: A Single-Center Experience with Emphasis on Complications and Management","volume":"27","author":"Kim","year":"2006","journal-title":"AJNR Am. J. Neuroradiol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1016\/S0002-9394(02)01515-5","article-title":"Dural Carotid Cavernous Fistula: Definitive Endovascular Management and Long-Term Follow-Up","volume":"134","author":"Meyers","year":"2002","journal-title":"Am. J. Ophthalmol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2113","DOI":"10.1007\/s00701-017-3336-4","article-title":"Long-Term Outcome After Endovascular Treatment of Cavernous Sinus Dural Arteriovenous Fistula and a Literature Review","volume":"159","author":"Nishimuta","year":"2017","journal-title":"Acta Neurochir."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"208","DOI":"10.3171\/JNS\/2008\/109\/8\/0208","article-title":"Cranial Nerve Palsy Following Transvenous Embolization for a Cavernous Sinus Dural Arteriovenous Fistula: Association with the Volume and Location of Detachable Coils","volume":"109","author":"Nishino","year":"2008","journal-title":"J. Neurosurg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"380","DOI":"10.1227\/NEU.0000000000000829","article-title":"Proposal of Venous Drainage-Based Classification System for Carotid Cavernous Fistulae With Validity Assessment in a Multicenter Cohort","volume":"77","author":"Thomas","year":"2015","journal-title":"Neurosurgery"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"290","DOI":"10.1136\/neurintsurg-2016-012742","article-title":"Novel Approaches to Access and Treatment of Cavernous Sinus Dural Arteriovenous Fistula (Cs-Davf): Case Series and Review of the Literature","volume":"9","author":"Wenderoth","year":"2017","journal-title":"J. Neurointerv. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"651","DOI":"10.3174\/ajnr.A1882","article-title":"Transvenous Embolization of Dural Carotid Cavernous Fistulas: A Series of 44 Consecutive Patients","volume":"31","author":"Yoshida","year":"2010","journal-title":"AJNR Am. J. Neuroradiol."},{"key":"ref_17","first-page":"1081","article-title":"Radiosurgery as a Treatment Alternative for Dural Arteriovenous Fistulas of the Cavernous Sinus","volume":"19","author":"Guo","year":"1998","journal-title":"AJNR Am. J. Neuroradiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"392","DOI":"10.1016\/j.surneu.2004.12.026","article-title":"Radiosurgery for Dural Arteriovenous Fistulas","volume":"64","author":"Koebbe","year":"2005","journal-title":"Surg. Neurol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"477","DOI":"10.2176\/nmc.43.477","article-title":"Gamma Knife Surgery for the Treatment of Spontaneous Dural Carotid-Cavernous Fistulas","volume":"43","author":"Onizuka","year":"2003","journal-title":"Neurol. Med. Chir."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"744","DOI":"10.1016\/j.jocn.2004.09.026","article-title":"Multidisciplinary Treatment of Cavernous Sinus Dural Arteriovenous Fistulae with Radiosurgery and Embolization","volume":"12","author":"Pan","year":"2005","journal-title":"J. Clin. Neurosci."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1148\/radiology.183.1.1549684","article-title":"Suspected Dural Arteriovenous Fistula: Results with Screening Mr Angiography in Seven Patients","volume":"183","author":"Chen","year":"1992","journal-title":"Radiology"},{"key":"ref_22","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","journal-title":"AJNR Am. J. Neuroradiol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1007\/BF00593339","article-title":"Intracerebral Hemorrhage in Carotid-Cavernous Fistula","volume":"33","author":"Hiramatsu","year":"1991","journal-title":"Neuroradiology"},{"key":"ref_24","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","journal-title":"AJNR Am. J. Neuroradiol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1016\/0360-3016(93)90262-T","article-title":"Cavernous Sinus Cranial Neuropathies: Is There a Dose-Response Relationship Following Radiosurgery?","volume":"27","author":"Mehta","year":"1993","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_26","first-page":"215","article-title":"Bilateral Acute Angle Closure Glaucoma and Myopia Induced by Topiramate","volume":"160","author":"Cruciani","year":"2009","journal-title":"Clin. Ter"},{"key":"ref_27","first-page":"471","article-title":"The Role of Episcleral Venous Pressure in the Development of Secondary Glaucomas","volume":"193","author":"Guthoff","year":"1988","journal-title":"Klin. Monbl. Augenheilkd."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"833","DOI":"10.1136\/bjophthalmol-2017-310801","article-title":"Predictors of Radio-Induced Visual Impairment after Radiosurgery for Uveal Melanoma","volume":"102","author":"Gigliotti","year":"2018","journal-title":"Br. J. Ophthalmol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"298","DOI":"10.1097\/00000421-199408000-00004","article-title":"Histopathologic Changes Following Irradiation for Uveal Tract Melanoma","volume":"17","author":"Petrovich","year":"1994","journal-title":"Am. J. Clin. Oncol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"S279","DOI":"10.4103\/2152-7806.157795","article-title":"Percutaneous Transluminal Angioplasty in a Patient with Internal Carotid Artery Stenosis Following Gamma Knife Radiosurgery for Recurrent Pituitary Adenoma","volume":"6","author":"Ito","year":"2015","journal-title":"Surg. Neurol. Int."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1159\/000056449","article-title":"Cerebral Infarction with Ica Occlusion after Gamma Knife Radiosurgery for Pituitary Adenoma: A Case Report","volume":"72","author":"Lim","year":"1999","journal-title":"Stereotact. Funct. Neurosurg."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"525","DOI":"10.3171\/jns.2002.97.3.0525","article-title":"Results of Stereotactic Radiosurgery in Patients with Hormone-Producing Pituitary Adenomas: Factors Associated with Endocrine Normalization","volume":"97","author":"Pollock","year":"2002","journal-title":"J. Neurosurg."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"E9","DOI":"10.3171\/foc.2007.22.3.10","article-title":"Vascular Complications after Radiosurgery for Meningiomas","volume":"22","author":"Barami","year":"2007","journal-title":"Neurosurg. Focus"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"2","DOI":"10.3171\/jns.2000.93.supplement_3.0002","article-title":"Stereotactic Radiosurgery for Pituitary Adenoma Invading the Cavernous Sinus","volume":"93","author":"Shin","year":"2000","journal-title":"J. Neurosurg."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"555","DOI":"10.1016\/j.rpor.2016.09.006","article-title":"Asymptomatic Internal Carotid Artery Occlusion after Gamma Knife Radiosurgery for Pituitary Adenoma: Report of Two Cases and Review of the Literature","volume":"21","author":"Spatola","year":"2016","journal-title":"Rep. Pract. Oncol. Radiother."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1159\/000107365","article-title":"Internal Carotid Occlusion Following Gamma Knife Radiosurgery for Cavernous Sinus Meningioma","volume":"85","author":"Abeloos","year":"2007","journal-title":"Stereotact. Funct. Neurosurg."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1159\/000341772","article-title":"Morphological Observations in Brain Arteriovenous Malformations after Gamma Knife Radiosurgery","volume":"27","author":"Szeifert","year":"2013","journal-title":"Prog. Neurol. Surg."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1159\/000416587","article-title":"Complications from Radiation Therapy to the Eye","volume":"23","author":"Brady","year":"1989","journal-title":"Front. Radiat. Ther. Oncol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"775","DOI":"10.1016\/0360-3016(94)90348-4","article-title":"Severe Dry-Eye Syndrome Following External Beam Irradiation","volume":"30","author":"Parsons","year":"1994","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"466","DOI":"10.1136\/bjophthalmol-2012-302402","article-title":"Influence of Single-Fraction Gamma-Knife Radiosurgery on Ocular Surface and Tear Function in Choroidal Melanoma Patients","volume":"97","author":"Schneider","year":"2013","journal-title":"Br. J. Ophthalmol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1136\/bjo.84.1.19","article-title":"Tear Secretion and Tear Film Function in Insulin Dependent Diabetics","volume":"84","author":"Goebbels","year":"2000","journal-title":"Br. J. Ophthalmol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1264","DOI":"10.1001\/archopht.118.9.1264","article-title":"Prevalence of and Risk Factors for Dry Eye Syndrome","volume":"118","author":"Moss","year":"2000","journal-title":"Arch. Ophthalmol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1001\/archopht.122.3.369","article-title":"Incidence of Dry Eye in an Older Population","volume":"122","author":"Moss","year":"2004","journal-title":"Arch. Ophthalmol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1097\/00002341-199903000-00012","article-title":"Low-Dose Radiotherapy for Lymphoid Lesions of the Orbit and Ocular Adnexa","volume":"15","author":"Kennerdell","year":"1999","journal-title":"Ophthalmic Plast. Reconstr. Surg."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"3153","DOI":"10.2147\/OPTH.S263291","article-title":"Ocular Complications After Radiation Therapy: An Observational Study","volume":"14","author":"Nuzzi","year":"2020","journal-title":"Clin. Ophthalmol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1016\/j.mrrev.2016.07.010","article-title":"Ionizing Radiation Induced Cataracts: Recent Biological and Mechanistic Developments and Perspectives for Future Research","volume":"770","author":"Ainsbury","year":"2016","journal-title":"Mutat. Res. Rev. Mutat. Res."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.icrp.2012.02.001","article-title":"ICRP Publication 118: ICRP Statement on Tissue Reactions and Early and Late Effects of Radiation in Normal Tissues and Organs\u2014Threshold Doses for Tissue Reactions in a Radiation Protection Context","volume":"41","author":"Stewart","year":"2012","journal-title":"Ann. ICRP"},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Liang, C.L., Liliang, P.C., Chen, T.B., Hsu, H.C., Chuang, F.C., Wang, K.W., Wang, H.K., Yang, S.N., and Chen, H.J. (2017). The Risk of Cataractogenesis after Gamma Knife Radiosurgery: A Nationwide Population Based Case-Control Study. BMC Ophthalmol., 17.","DOI":"10.1186\/s12886-017-0435-1"}],"container-title":["Life"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-1729\/12\/8\/1175\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T00:00:56Z","timestamp":1760140856000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-1729\/12\/8\/1175"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,8,1]]},"references-count":48,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2022,8]]}},"alternative-id":["life12081175"],"URL":"https:\/\/doi.org\/10.3390\/life12081175","relation":{},"ISSN":["2075-1729"],"issn-type":[{"type":"electronic","value":"2075-1729"}],"subject":[],"published":{"date-parts":[[2022,8,1]]}}}