title: Stereotactic radiosurgery for intracranial dural arteriovenous fistulas: a systematic review.
abstract: OBJECTIVE
  The goal of this study was to evaluate the obliteration rate of intracranial dural arteriovenous fistulas (DAVFs) in patients treated with stereotactic radiosurgery (SRS), and to compare obliteration rates between cavernous sinus (CS) and noncavernous sinus (NCS) DAVFs, and between DAVFs with and without cortical venous drainage (CVD).
  
  
  METHODS
  A systematic literature review was performed using PubMed. The CS DAVFs and the NCS DAVFs were categorized using the Barrow and Borden classification systems, respectively. The DAVFs were also categorized by location and by the presence of CVD. Statistical analyses of pooled data were conducted to assess complete obliteration rates in CS and NCS DAVFs, and in DAVFs with and without CVD.
  
  
  RESULTS
  Nineteen studies were included, comprising 729 patients harboring 743 DAVFs treated with SRS. The mean obliteration rate was 63% (95% CI 52.4%-73.6%). Complete obliteration for CS and NCS DAVFs was achieved in 73% and 58% of patients, respectively. No significant difference in obliteration rates between CS and NCS DAVFs was found (OR 1.72, 95% CI 0.66-4.46; p=0.27). Complete obliteration in DAVFs with and without CVD was observed in 56% and 75% of patients, respectively. A significantly higher obliteration rate was observed in DAVFs without CVD compared with DAVFs with CVD (OR 2.37, 95% CI 1.07-5.28; p=0.03).
  
  
  CONCLUSIONS
  Treatment with SRS offers favorable rates of DAVF obliteration with low complication rates. Patients harboring DAVFs that are refractory or not amenable to endovascular or surgical therapy may be safely and effectively treated using SRS.
authors.affiliation: Departments of 1 Neurological Surgery and.
authors.forename: Ching-Jen
authors.initials: CJ
authors.lastname: Chen
authors.forename: Cheng-Chia
authors.initials: CC
authors.lastname: Lee
authors.forename: Dale
authors.initials: D
authors.lastname: Ding
authors.forename: Robert M
authors.initials: RM
authors.lastname: Starke
authors.forename: Srinivas
authors.initials: S
authors.lastname: Chivukula
authors.forename: Chun-Po
authors.initials: CP
authors.lastname: Yen
authors.forename: Shayan
authors.initials: S
authors.lastname: Moosa
authors.forename: Zhiyuan
authors.initials: Z
authors.lastname: Xu
authors.forename: David Hung-Chi
authors.initials: DH
authors.lastname: Pan
authors.forename: Jason P
authors.initials: JP
authors.lastname: Sheehan
mesh_terms: D000368:Aged; D002426:Cavernous Sinus / Q000601:surgery; D020785:Central Nervous System Vascular Malformations / Q000601:surgery*; D004322:Drainage; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016634:Radiosurgery; D016896:Treatment Outcome
keywords: AVM = arteriovenous malformation; CS = cavernous sinus; CVD = cortical venous drainage; DAVF = dural arteriovenous fistula; GKS = Gamma Knife surgery; LINAC = linear accelerator; NCS = noncavernous sinus; SRS = stereotactic radiosurgery; TSS = transverse and sigmoid sinus; arteriovenous fistula; dural arteriovenous fistula; radiosurgery; review; stereotactic radiosurgery