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James K. Liu, Kelly Mahaney, Stanley L. Barnwell, Sean O. McMenomey and Johnny B. Delashaw Jr.

hypoglossal canal can also contain meningeal branches of the ascending pharyngeal artery that become clinically significant when they become feeding arteries of a DAVF. Treatment of Hypoglossal Canal DAVFs Several treatment options can be used to obliterate these DAVFs, including endovascular therapy (transvenous or transarterial embolization), surgery, or both. The pattern of venous drainage can help determine the optimal treatment strategy. Transfemoral transvenous embolization is very effective and appears to be the treatment of choice in eliminating DAVFs; however

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James K. Liu, Yuan Lu, Ahmed M. Raslan, S. Humayun Gultekin and Johnny B. Delashaw Jr.

patients who underwent STR, 2 had visual improvement and 2 had no change. Biopsy procedure alone resulted in stable vision in 2 patients; there was no visual outcome data in the other 2 patients. 61 Biopsy procedure with decompression resulted in a 77% rate of visual improvement, 15% visual stabilization, and 8% visual worsening. Biopsy procedure followed by radiation therapy resulted in visual stabilization in 1 patient. TABLE 2: Visual outcomes in patients with OPH CMs * Treatment (no. of cases) % w/ Visual Improvement (no.) % w/ Visual

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James K. Liu, Maria Fleseriu, Johnny B. Delashaw Jr., Ivan S. Ciric, William T. Couldwell and Ph.D.

. Unfortunately, the results of endocrinological analyses after transsphenoidal surgery vary in the literature because different definitions of a biochemical cure are given in the various studies. If biochemical evidence of Cushing disease persists or recurs after an initial transsphenoidal surgery, the surgeon should be familiar with the treatment options available to offer the patient, including repeat transsphenoidal surgery, radiation therapy, medical therapy, and bilateral adrenalectomy. A multimodal approach using a combination of these treatments may be an appropriate

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James K. Liu, Aclan Dogan, Dilantha B. Ellegala, Jonathan Carlson, Gary M. Nesbit, Stanley L. Barnwell and Johnny B. Delashaw Jr.

(transarterial and/or transvenous) embolization, 9 , 10 , 24 , 26–29 , 36 , 55 and radiation therapy (conventional or stereotactic radiosurgery). 7 , 13 , 20 , 30 , 38 , 39 , 44 , 47 Excision often requires an extensive operation associated with significant morbidity. 49 With radiation therapy, there is a lag time of up to 2 years before thrombosis of the lesion takes effect while these aggressive DAVFs remain prone to hemorrhage. 39 The effectiveness and durability of obliteration is also unknown with incomplete obliteration rates. Endovascular therapy has gained much