Dural arteriovenous fistulas and the role of gamma knife stereotactic radiosurgery: the Stockholm experience.

We review the clinical and radiological outcomes of patients with dural arteriovenous fistulae (DAVFs), treated with the Gamma Knife® (GK) in Stockholm. During the period 1972-2008, 73 consecutive patients were treated. Eight were excluded due to lack of follow-up. Thus, the material comprises 65 patients harboring 67 DAVFs subjected to 75 treatments with GK stereotactic radiosurgery (SRS). Fifty-four cases were subjected to upfront GK SRS while 13 followed failed surgery or embolization. Nine patients had been retreated with GK SRS. One was recent and was excluded. Prescription doses varied considerably, but most commonly it was 20-25 Gy to the 40-60% isodose. Target definition was from angiography in all cases. 63 cases had an angiographic follow-up. There were 37 (59%) obliterations and 17 (27%) regressions. Nine lesions were unchanged (14%). If patients with clinical data suggestive of obliteration or magnetic resonance imaging follow-up are included, the numbers differ. Two patients are excluded. As for the 73 remaining cases, there were 46 (63%) obliterations, 17 (23%) regressions and 10 (14%) unchanged. There were 2 posttreatment hemorrhages and 5 minor adverse radiation effects. GK SRS is an effective treatment for DAVFs, with a low incidence of complications. GK SRS is a treatment alternative for patients harboring a DAVF without cortical venous reflux that causes intolerable bruit and to those not amenable to embolization or surgery.