Gamma knife radiosurgery treatment of cavernous dural fistula

A cavernous dural fistula is a condition that can be caused by trauma. There are many methods of treating cavernous dural fistula, but Gamma knife radiosurgery is a new method with many advantages over previous methods.

A cavernous sinus dural artery fistula (venous sinus) is the appearance of an abnormal anastomosis from the artery and venous portion of the venous system located on the dural surface. The consequence of this anastomosis is that the arterial blood flows in, the pressure in the cavernous sinus increases, flows back to the ophthalmic vein, causing stagnation of the circulation of the eye and orbit.
Depending on the degree of pressure increase in the cavernous sinus and the patient has symptoms of acute or progressive disease.
The cause of cavernous sinus dura is mainly due to trauma (traffic accident, labor accident...) or there are other cases due to spontaneous detection of unknown cause.

Manifestations of cavernous dural fistula vary widely depending on the severity and duration of the disease. Symptoms include:
Symptoms appear slowly increasing: Conjunctival congestion causes red eyes, vision loss, maybe a slight pain in the eye that does not respond to treatment with conventional drugs. If not treated for a long time, it can cause ocular manifestations such as: protrusion, conjunctival edema, fundus damage (papilloedema, papilledema, retinal hemorrhage)), retinal vascular occlusion, corneal ulceration retina, glaucoma, and decreased or lost vision. Paralysis of the eye causes drooping eyelids, double vision, and limited eye movement. There is a risk of cerebral hemorrhage, cerebral varicose veins.

With cavernous dural fistula, there are 3 treatment methods including:
Surgery: Invasive method to intervene in the location of the leak. This method is quite complicated and can have many complications. Embolization: This method is less invasive, is conducted by arterial line, the catheter is threaded into the artery to the fistula, then the embolization agent is injected. However, in cases where the arteries entering the cavernous artery fistula are too small or numerous, it is not possible to insert the catheter into the malformation through the artery. The cases of large probe size also cannot be interfered with by the circuit breaker. Gamma knife radiosurgery: A surgical method using concentrated gamma radiation. Currently, this method is preferred due to its many advantages, including non-invasiveness, quick recovery time after surgery.

4.1 Effect of gamma knife surgery The choice of treatment with gamma knife surgery is to limit the disadvantages of surgery and embolization:
Surgery: Invasive, with risk of blood loss and many possible complications. out after surgery. Embolization: It is not possible to embolize the vessel if the size is large, the case of the small blood vessel, the zigzag, difficult to thread the microtubule. Also an invasive method in the body, there is a risk of complications such as infection, bleeding... Gamma knife radiosurgery is a method of using concentrated high-energy gamma radiation and causing local effects in the body. diseases such as:
Causing edema, endothelial cell degeneration and necrosis. Proliferation of the vascular endothelial layer. Narrowing of blood vessels. Embolization and narrowing of blood vessels. Cavernous sinus fistula obstruction. From the above effects, after being affected by gamma radiation, the cavernous dural fistula site will gradually cause obstruction. In addition, the application of gamma knife radiosurgery is applied in surgery to treat tumors, especially brain tumors due to its ability to destroy target cells and destroy brain tumor cells.
4.2 Advantages and disadvantages of gamma knife radiosurgery The advantages of gamma knife radiosurgery include:
Can be used to treat all types of cavernous dural fistula less than 5cm in size. In particular, some cases are contraindicated for surgery and embolization. Gamma knife radiosurgery is a non-invasive method. Patients do not need much preparation before surgery. The procedure is quick, the hospital stay is short, only 1-2 days, there is no risk of bleeding or infection. Cons
Usually does not give an immediate effect, helping to block the probe position but will make the probe position smaller over time. Cannot be treated when the size is too large (over 5cm). Being a high technology requires a team of highly trained medical professionals. The cost of treatment is quite high, because the gamma knife machine is not yet available. 4.3 Follow-up after gamma knife radiosurgery After treatment, there is no immediate effect, so it is necessary to have regular check-ups every month after treatment. Or any time there are unusual signs. Cranial MRI is indicated every 6 months to assess structural changes in the lesion. Monitoring for complications, patients may appear symptoms such as headache, nausea, vomiting after surgery, which may go away on their own. However, the complication rate is low. Usually patients are exposed to radiation during treatment, but after treatment the radiation status is no longer. So there is no need to isolate or worry about radioactive contamination.

Cavernous dural fistula is a dangerous condition, which can cause many complications and endanger the life of the model. Gamma knife radiosurgery in the treatment of cavernous dura mater is a non-invasive method with few complications and good prognosis, especially in some cases with contraindications to surgery and embolization.
Vinmec International General Hospital is one of the hospitals that not only ensures professional quality with a team of leading medical doctors, modern equipment and technology, but also stands out for its examination and consultation services. comprehensive and professional medical consultation and treatment; civilized, polite, safe and sterile medical examination and treatment space.

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