EBS presentation 1
“ Efficacy and safety of radiosurgery in
patients with intracranial dural
arteriovenous fistulae”
Santh...
EBS presentation 2
Background
• 41 year old doctor diagnosed to have a right
transverse sigmoid junction dural AV fistula
...
EBS presentation 3
Searchable question (PICO format)
• P – Patients with intracranial dural av fistulae,
• I – Radiosurger...
EBS presentation 4
Search strategy
• Ovid Medline
• Embase
• Scopus
• Cochrane Reviews
EBS presentation 5
Medline
EBS presentation 6
Embase
EBS presentation 7
EBS presentation 8
PRISMA flow diagram
Embase 65
Medline 43
After duplicates removed in end note, 165
articles
13 articles...
EBS presentation 9
Summary of papers
• Only 13 studies with reqd data (N=821)
with Cortical venous drainage (N=299,
~37% o...
EBS presentation 10
Clinical
Presentation
Mean (%) 95% CI Lower
limit
95% CI Upper
limit
Tinnitus/Bruit 42.57% 35.96 49.47...
EBS presentation 11
• Previous Craniotomy in 5.22% (95% CI 3.68-
7.64)
• Previous / Immediate post SRS embolisation
in 28....
EBS presentation 12
64.62%
EBS presentation 13
4.51% (Hemorrhage/ Radiation necrosis/ Neurological deficit)
EBS presentation 14
• Mortality was 0.24% (only 2 cases, 95% CI
0.01-0.94)
• ~37% of the group had CVD
EBS presentation 15
Conclusions
• Difficult condition to treat effectively
• Though a total of ~33% pts had received
some ...
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Efficacy and safety of radiosurgery in patients with intracranial dural arteriovenous fistulae

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Efficacy and safety of radiosurgery in patients with intracranial dural arteriovenous fistulae

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  • Efficacy and safety of radiosurgery in patients with intracranial dural arteriovenous fistulae

    1. 1. EBS presentation 1 “ Efficacy and safety of radiosurgery in patients with intracranial dural arteriovenous fistulae” Santhosh George Thomas Evidence Based Surgery presentation 11/08/2014
    2. 2. EBS presentation 2 Background • 41 year old doctor diagnosed to have a right transverse sigmoid junction dural AV fistula • Options of treatment explained • Question of efficacy of SRS
    3. 3. EBS presentation 3 Searchable question (PICO format) • P – Patients with intracranial dural av fistulae, • I – Radiosurgery • C - • O –Safety and efficacy Question: What is the efficacy and safety of radiosurgery in patients with intracranial dural arteriovenous fistulae?
    4. 4. EBS presentation 4 Search strategy • Ovid Medline • Embase • Scopus • Cochrane Reviews
    5. 5. EBS presentation 5 Medline
    6. 6. EBS presentation 6 Embase
    7. 7. EBS presentation 7
    8. 8. EBS presentation 8 PRISMA flow diagram Embase 65 Medline 43 After duplicates removed in end note, 165 articles 13 articles for review - Not relevant after title and/ or abstract screening -Excluded case reports/reviews/letter to the editor (4) - Excluded 4 articles by the same group from 2002-2013 Scopus 98 Cochrane 0
    9. 9. EBS presentation 9 Summary of papers • Only 13 studies with reqd data (N=821) with Cortical venous drainage (N=299, ~37% of the total) • 4 were prospective and 9 retrospective • 3 Linac systems and 10 GKS • Mean and 95% CI calculated using the modified Wald’s method
    10. 10. EBS presentation 10 Clinical Presentation Mean (%) 95% CI Lower limit 95% CI Upper limit Tinnitus/Bruit 42.57% 35.96 49.47 Hemorrhage 26.24 % 20.64 32.72 Chemosis/heada che 21.29 % 16.18 27.47 Neurological Deficit 4.95% 2.6 8.98 Acute Hydrocephalus 1.98% 0.59 5.16
    11. 11. EBS presentation 11 • Previous Craniotomy in 5.22% (95% CI 3.68- 7.64) • Previous / Immediate post SRS embolisation in 28.79% (95% CI 25.29 -32.56) • Mean follow up 40.72 months • Mean prescribed dose was 19.7 GY
    12. 12. EBS presentation 12 64.62%
    13. 13. EBS presentation 13 4.51% (Hemorrhage/ Radiation necrosis/ Neurological deficit)
    14. 14. EBS presentation 14 • Mortality was 0.24% (only 2 cases, 95% CI 0.01-0.94) • ~37% of the group had CVD
    15. 15. EBS presentation 15 Conclusions • Difficult condition to treat effectively • Though a total of ~33% pts had received some previous modality of treatment, the three and half year complete obliteration rate was only 64% • This came with a morbidity of ~4.5% • May not suitable as a first line treatment strategy • Not very effective in fistulae with CVD
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