title: Radiosurgery for dural arteriovenous fistulas.
abstract: OBJECTIVE
  Dural arteriovenous fistulas (DAVFs) comprise 10% to 15% of all arteriovenous malformations. Recent studies have demonstrated promising results when radiosurgery is used for DAVFs. We retrospectively analyzed our patients with DAVFs who received stereotactic radiosurgery with or without embolization.
  
  
  METHODS
  Between 1991 and 2002, 18 patients with 23 angiographically confirmed symptomatic DAVFs underwent gamma knife radiosurgery, either alone (n = 8) or in combination with embolization (n = 10). A retrospective chart review was performed to identify DAVF location, venous drainage pattern, radiosurgery dosimetry, clinical outcomes, and imaging results. The series included 9 men and 9 women with a mean age of 65 (range 50-89) years. Nine patients received particulate, coil, and/or absolute ethanol embolization before radiosurgery, and 1 patient received particulate embolization after radiosurgery. The mean duration of clinical follow-up was 43 (range 2-116) months. The mean margin radiosurgery dose was 20 (range 15-30) Gy.
  
  
  RESULTS
  Nine patients had complete resolution of their presenting symptoms, and 9 patients had resolution of all but 1 of their presenting symptoms. Angiographic follow-up (mean 46 months) was performed on 8 patients demonstrating complete obliteration in all the cases. Seven patients evaluated by magnetic resonance angiography or computed tomography angiography showed no evidence of DAVF (4 patients) or decreased DAVF size (3 patients). After radiosurgery, 1 patient developed a temporary hemiparesis. Two permanent neurological deficits occurred after embolization before radiosurgery. No patient had an intracranial hemorrhage after treatment.
  
  
  CONCLUSIONS
  Stereotactic radiosurgery provides effective long-term relief of symptoms in selected patients with DAVFs.
authors.affiliation: Department of Neurological Surgery, Center for Image-Guided Neurosurgery, University of Pittsburgh, Pittsburgh, PA 15213, USA.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Koebbe
authors.forename: Dhruv
authors.initials: D
authors.lastname: Singhal
authors.forename: Jason
authors.initials: J
authors.lastname: Sheehan
authors.forename: John C
authors.initials: JC
authors.lastname: Flickinger
authors.forename: Michael
authors.initials: M
authors.lastname: Horowitz
authors.forename: Douglas
authors.initials: D
authors.lastname: Kondziolka
authors.forename: L Dade
authors.initials: LD
authors.lastname: Lunsford
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020785:Central Nervous System Vascular Malformations / Q000601:surgery*; D003072:Cognition Disorders / Q000209:etiology; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016634:Radiosurgery / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome