Stereotactic Radiosurgery for Dural Arteriovenous Fistulas

An intracranial dural arteriovenous fistula (DAVF) is considered an acquired disease. DAVFs with anterograde cortical venous drainage (CVD) are considered benign, whereas DAVFs with retrograde CVD are considered aggressive. Stereotactic radiosurgery (SRS) is indicated as an initial treatment for DAVFs without CVD or DAVFs with asymptomatic CVD. An obliteration rate of 70% is expected for cavernous sinus DAVFs and 60% for non-cavernous sinus DAVFs. Few complications have been reported with SRS. Surgery or endovascular treatment (e.g., embolization and angioplasty) is indicated for aggressive DAVFs with extensive CVD, due to the immediate risks of hemorrhage, progressive neurological deficit, and/or severe venous hypertension.