BACKGROUND: Dural arteriovenous fistulas (DAVFs) can be categorized based on location. OBJECTIVE: To compare stereotactic radiosurgery (SRS) outcomes between cavernous sinus (CS) and non-CS DAVFs and to identify respective outcome predictors. METHODS: This is a retrospective study of DAVFs treated with SRS between 1988 and 2016 at 10 institutions. Patients' variables, DAVF characters, and SRS parameters were included for analyses. Favorable clinical outcome was defined as angiography-confirmed obliteration without radiological radiation-induced changes (RIC) or post-SRS hemorrhage. Other outcomes were DAVFs obliteration and adverse events (including RIC, symptomatic RIC, and post-SRS hemorrhage). RESULTS: The overall study cohort comprised 131 patients, including 20 patients with CS DAVFs (15%) and 111 patients with non-CS DAVFs (85%). Rates of favorable clinical outcome were comparable between the 2 groups (45% vs 37%, P = .824). Obliteration rate after SRS was higher in the CS DAVFs group, even adjusted for baseline difference (OR = 4.189, P = .044). Predictors of favorable clinical outcome included higher maximum dose (P = .014) for CS DAVFs. Symptomatic improvement was associated with obliteration in non-CS DAVFs (P = .005), but symptoms improved regardless of whether obliteration was confirmed in CS DAVFs. Non-CS DAVFs patients with adverse events after SRS were more likely to be male (P = .020), multiple arterial feeding fistulas (P = .018), and lower maximum dose (P = .041). CONCLUSION: After SRS, CS DAVFs are more likely to obliterate than non-CS ones. Because these 2 groups have different total predictors for clinical and radiologic outcomes after SRS, they should be considered as different entities.

Department of Neurological Surgery Na Homolce Hospital Prague Czech Republic

Department of Neurological Surgery Université de Sherbrooke Centre de recherche du CHUS Sherbrooke Canada

Department of Neurological Surgery University of Manitoba Winnipeg Canada

Department of Neurological Surgery University of Miami Miami Florida

Department of Neurological Surgery University of Pennsylvania Philadelphia Pennsylvania

Department of Neurological Surgery University of Pittsburgh Pittsburgh Pennsylvania

Department of Neurological Surgery University of Puerto Rico San Juan Puerto Rico

Department of Neurological Surgery University of Virginia Charlottesville Virginia

Department of Neurological Surgery West Virginia University Morgantown West Virginia

Department of Radiation Oncology Beaumont Health System Royal Oak Michigan

Department of Radiation Oncology West Virginia University Morgantown West Virginia

Division of Neurosurgery Department of Surgery Chi Mei Medical Center Tainan Taiwan Department of Recreation and Healthcare Management Chia Nan University of Pharmacy and Science Tainan Taiwan Department of Neurological Surgery University of Virginia Charlottesville Virginia

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$a Hung, Yi-Chieh $u Division of Neurosurgery, Department of Surgery, Chi-Mei Medical Center, Tainan, Taiwan. Department of Recreation and Healthcare Management, Chia Nan University of Pharmacy and Science, Tainan, Taiwan. Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia.

245    10

$a Stereotactic Radiosurgery for Cavernous Sinus Versus Noncavernous Sinus Dural Arteriovenous Fistulas: Outcomes and Outcome Predictors / $c YC. Hung, N. Mohammed, KN. Kearns, CJ. Chen, RM. Starke, H. Kano, J. Lee, D. Mathieu, AM. Kaufmann, WG. Wang, IS. Grills, CP. Cifarelli, J. Vargo, T. Chytka, L. Janouskova, CE. Feliciano, R. Rodriguez-Mercado, LD. Lunsford, JP. Sheehan,

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$a BACKGROUND: Dural arteriovenous fistulas (DAVFs) can be categorized based on location. OBJECTIVE: To compare stereotactic radiosurgery (SRS) outcomes between cavernous sinus (CS) and non-CS DAVFs and to identify respective outcome predictors. METHODS: This is a retrospective study of DAVFs treated with SRS between 1988 and 2016 at 10 institutions. Patients' variables, DAVF characters, and SRS parameters were included for analyses. Favorable clinical outcome was defined as angiography-confirmed obliteration without radiological radiation-induced changes (RIC) or post-SRS hemorrhage. Other outcomes were DAVFs obliteration and adverse events (including RIC, symptomatic RIC, and post-SRS hemorrhage). RESULTS: The overall study cohort comprised 131 patients, including 20 patients with CS DAVFs (15%) and 111 patients with non-CS DAVFs (85%). Rates of favorable clinical outcome were comparable between the 2 groups (45% vs 37%, P = .824). Obliteration rate after SRS was higher in the CS DAVFs group, even adjusted for baseline difference (OR = 4.189, P = .044). Predictors of favorable clinical outcome included higher maximum dose (P = .014) for CS DAVFs. Symptomatic improvement was associated with obliteration in non-CS DAVFs (P = .005), but symptoms improved regardless of whether obliteration was confirmed in CS DAVFs. Non-CS DAVFs patients with adverse events after SRS were more likely to be male (P = .020), multiple arterial feeding fistulas (P = .018), and lower maximum dose (P = .041). CONCLUSION: After SRS, CS DAVFs are more likely to obliterate than non-CS ones. Because these 2 groups have different total predictors for clinical and radiologic outcomes after SRS, they should be considered as different entities.

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$a Mohammed, Nasser $u Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia.

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$a Kearns, Kathryn N $u Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia.

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$a Chen, Ching-Jen $u Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia.

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$a Starke, Robert M $u Department of Neurological Surgery, University of Miami, Miami, Florida.

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$a Kano, Hideyuki $u Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania.

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$a Lee, John $u Department of Neurological Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.

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$a Mathieu, David $u Department of Neurological Surgery, Université de Sherbrooke, Centre de recherche du CHUS, Sherbrooke, Canada.

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$a Kaufmann, Anthony M $u Department of Neurological Surgery, University of Manitoba, Winnipeg, Canada.

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$a Wang, Wei Gang $u Department of Radiation Oncology, Beaumont Health System, Royal Oak, Michigan.

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$a Grills, Inga S $u Department of Radiation Oncology, Beaumont Health System, Royal Oak, Michigan.

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$a Cifarelli, Christopher P $u Department of Neurological Surgery, West Virginia University, Morgantown, West Virginia.

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$a Vargo, John $u Department of Radiation Oncology, West Virginia University, Morgantown, West Virginia.

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$a Chytka, Tomas $u Department of Neurological Surgery, Na Homolce Hospital, Prague, Czech Republic.

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$a Janouskova, Ladislava $u Department of Neurological Surgery, Na Homolce Hospital, Prague, Czech Republic.

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$a Feliciano, Caleb E $u Department of Neurological Surgery, University of Puerto Rico, San Juan, Puerto Rico.

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$a Rodriguez-Mercado, Rafael $u Department of Neurological Surgery, University of Puerto Rico, San Juan, Puerto Rico.

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$a Lunsford, L Dade $u Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania.

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$a Sheehan, Jason P $u Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia.

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