# Repeated stereotactic radiosurgery for residual intracranial dural arteriovenous fistulas

## TL;DR

This study shows that repeated stereotactic radiosurgery is safe and effective for treating residual brain arteriovenous fistulas.

## Contribution

The study provides new evidence on the safety and efficacy of repeated stereotactic radiosurgery for residual dural arteriovenous fistulas.

## Key findings

- Symptomatic improvement was observed in 84.2% of patients after repeated SRS.
- Complete radiologic obliteration was achieved in 57.9% of patients.
- No intracranial hemorrhage occurred, and only one patient experienced a minor radiation-related complication.

## Abstract

Stereotactic radiosurgery (SRS) is widely used for the treatment of intracranial dural arteriovenous fistulas (DAVFs); however, the outcomes of repeated SRS to deal with residual DAVFs are unclear. This study assessed the benefits and potential negative consequences of repeated SRS in patients with residual DAVFs.

This retrospective study examined all patients who underwent two SRS procedures for DAVFs in a single academic medical center between January 1998 and December 2022. Information related to patient demography, DAVFs characteristics, and clinical outcomes were obtained from medical records. The objective in this study was to obtain a preliminary overview of the results of repeated SRS for DAVFs.

The study cohort of 19 patients included 14 patients with non-cavernous sinus (NCS) DAVFs and 5 patients with cavernous sinus (CS) DAVFs. The NCS group included 8 patients who were categorized as low-grade (Borden grade 1) and 6 as high-grade (Borden grade 2 or 3). The median follow up duration after the second session of SRS was 37 months. Symptomatic improvement was noted in 16 patients (84.2%) and total obliteration was identified in 11 patients (57.9%). No patient suffered from intracranial hemorrhage after the repeated SRS. One patient (5.3%) experienced symptomatic radiation-induced change mandating temporary course of medical treatment.

Repeated SRS appears to be a safe and effective approach to deal with residual DAVFs, resulting in symptomatic improvement and complete radiologic obliteration.