Abstract
Intracranial dural arteriovenous fistulas (DAVFs) are characterized by abnormal shunting between the dural arteries and sinuses or cortical veins, potentially leading to intracranial hemorrhage or non-hemorrhagic neurological deficits. Although the traditional treatment options for DAVFs include endovascular therapy and direct surgery, recent findings support the efficacy of stereotactic radiosurgery (SRS) as a viable alternative. This review addresses the latest evidence regarding the efficacy and safety of SRS for DAVFs and provides insights into its role in treating intractable cases. SRS is a highly precise localized radiation therapy and has demonstrated 5-year cumulative complete obliteration rates ranging 67–89% with minimal adverse events (0–3%). Factors predicting treatment success include the absence of cortical venous reflux and specific DAVF locations, such as the cavernous and transverse-sigmoid sinuses, as confirmed through multicenter retrospective studies. In addition, in transverse-sigmoid sinus DAVFs, SRS has been shown to preserve diseased venous sinuses that contribute to normal venous drainage, thereby identifying it as an effective treatment, particularly for Borden type I DAVFs. Furthermore, SRS may play a crucial role in managing high-flow shunts with hemorrhagic risks as well as recurrent or multifocal DAVFs when used in conjunction with other therapeutic modalities. Future studies involving international multi-center larger cohorts are required to further elucidate the role of SRS in the treatment of complex and refractory DAVFs.
