Radiosurgery for Dural Arteriovenous Fistulas.

Intracranial dural arteriovenous fistulas (DAVFs) are abnormal arteriovenous connections within the dura, in which meningeal arteries shunt blood directly into the dural sinus or leptomeningeal veins. Among all the treatment options for the treatment of DAVFs, stereotactic radiosurgery (SRS) is a safe and effective modality. SRS provides a minimally invasive therapy for patients who harbor less aggressive DAVFs without cortical vein drainage (CVD), but who suffer from intolerable headache, bruit, or ocular symptoms. For more aggressive DAVFs with CVD associated with immediate risks of hemorrhage, initial treatment with endovascular embolization or surgery for the prompt elimination of the aggressive components of DAVFs is necessary. In such cases, radiosurgery may serve as a secondary treatment for further management of residual nidus after initial intervention. The latent period for the effects of radiation to occur and the longer time for cure compared to surgery and endovascular therapy remains a major drawback for radiosurgery. However, the gradual obliteration of a DAVF after radiosurgery can avoid the immediate risk of aggravated venous hypertension or infarction, which sometimes complicates endovascular embolization and surgery.