Stereotactic radiosurgery for intracranial dural arteriovenous fistulas: a systematic review.
OBJECT
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.
['Chen|Ching-Jen|CJ|', 'Lee|Cheng-Chia|CC|', 'Ding|Dale|D|', 'Starke|Robert M|RM|', 'Chivukula|Srinivas|S|', 'Yen|Chun-Po|CP|', 'Moosa|Shayan|S|', 'Xu|Zhiyuan|Z|', 'Pan|David Hung-Chi|DH|', 'Sheehan|Jason P|JP|']
D000368:Aged D002426:Cavernous Sinus D020785:Central Nervous System Vascular Malformations D004322:Drainage D005260:Female D006801:Humans D008297:Male D008875:Middle Aged D016634:Radiosurgery D016896:Treatment Outcome
stereotactic radiosurgery radiosurgery dural arteriovenous fistula arteriovenous fistula review 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