Abstract
Objective: Stereotactic radiosurgery (SRS) is a minimally invasive treatment option for intracranial dural arteriovenous fistulas (DAVF). To further improve radiosurgical outcomes, we started integrating high spatial resolution images obtained by 3-dimensional rotational angiography (3DRA) into SRS (3DRA-SRS) for DAVF in 2015. This study aimed to validate its efficacy in comparison to that of MRI-based conventional SRS (c-SRS). Methods: Sixty-five patients who underwent SRS for DAVF at our hospital between June 1990 and May 2023 were retrospectively enrolled. The primary outcome was DAVF obliteration, and the secondary outcomes included post-SRS hemorrhage, symptom improvement, and adverse radiation events. Results: 3DRA-SRS was performed in 30 patients and c-SRS in 35 underwent c-SRS. The cumulative DAVF obliteration rates in the 3DRA-SRS group were significantly higher than those in the c-SRS group (72% vs. 31% at 2 years and 83% vs. 69% at 5 years; log-rank test; p = 0.010). Multivariable Cox proportional hazard analysis showed 3DRA-SRS was significantly associated with higher DAVF obliteration rate (hazard ratio [HR] 2.09, 95% confidence interval [CI] 1.09–4.00, p = 0.026), and absence of CVR was marginally associated (HR 1.90, 95% CI 0.99–3.63, p = 0.053). Additionally, the cumulative hemorrhagic stroke-free survival was 96% over 10 years in the entire cohort, with no significant difference between the two groups. The cumulative symptom improvement rates in the 3DRA-SRS group were significantly higher than those in the c-SRS group (80% vs. 39% at one year and 100% vs. 54% at two years, respectively; log-rank test; p = 0.002). Conclusions: 3DRA-SRS provides better radiosurgical outcomes for DAVF. Further research is required to confirm these long-term benefits.
