Effect of Radiotherapy on Dural Arteriovenous Malformation

Long-term Follow-up Study and Clinical Evaluation

Abstract

Treatment of dural arteriovenous malformation (DAVM) has not yet been established. Since 1976, the authors have performed radiation therapy on 12 DAVM cases, consisting of 5 in the cavernous portion and 7 in the posterior fossa area. Extraaxial irradiation of ⁶⁰Co, 100-200 rad, 2-3 times per week was focused on the nidus of DAVM and on the angiomatous abnormal vascular network. Total doses of ⁶⁰Co irradiation ranged from 1, 000 to 10, 000 rad, with a mean value of 4, 700 rad. In 11 cases out of 12, DAVM disappeared completely, as proved by angiography. The other case refused angiography and the disappearance of DAVM could not be proved. Outcome was good compared to untreated cases or cases treated by other methods. Complete disappearance of DAVM began 1 to 14 months after irradiation. The post-irradiational observation period was from 16 months to 6 years 10 months. Side effects such as radiation necrosis, occlusion of the main arterial trunk, occlusion of the venous sinus, visual or optic nerve disturbance, and appearance of meningioma did not occur in this series. Radiation therapy was considered to be effective and to produce minimal adverse effects. It should be considered the first choice in the treatment of DAVM.