Feasibility, Safety, and Outcomes of Stereotactic Radiosurgery in Intracranial Dural Arteriovenous Fistula: A Systematic Review

The main objective of this study is to evaluate the feasibility, safety, and clinical outcomes of stereotactic radiosurgery (SRS) in treating intracranial dural arteriovenous fistulas (dAVF). A thorough search across four databases identified 398 relevant publications. After removing duplicates using Rayyan QCRI and screening for relevance, the search yielded 232 publications, of which 30 full-text articles were reviewed, and 5 met the eligibility criteria for evidence synthesis. We included 5 studies with a total of 289 patients diagnosed with dAVFs, a total of 293 fistulas that underwent repair, and 168 (58.1%) were males. The median follow-up duration ranged from 17 months to 62 months. The obliteration rate ranged from 48% to 70.6%, with a total of 170 (58%). Nearly 71% of patients with pre-treatment symptoms experienced post-SRS symptom relief, particularly in cavernous sinus dAVFs. Radiation-induced changes (RIC) occurred in 14.5% of cases, with males and those with multiple arterial feeders being at higher risk. Post-SRS hemorrhage was rare, though prior hemorrhage increased susceptibility. Higher radiation doses were associated with improved obliteration rates, while new arterial feeders in adjacent sinuses led to retreatment in select cases. SRS is a safe and effective treatment for intracranial dAVFs, demonstrating high obliteration rates and symptom relief. However, long-term follow-up is essential due to the potential for new arterial feeders and delayed obliteration. Future research should focus on standardizing treatment protocols, refining patient selection, and developing predictive models to further optimize SRS outcomes for dAVFs.