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Dural Arteriovenous Fistulas

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Abstract

Dural arteriovenous fistulas (DAVFs) are pathological, direct transcranial connections from extracranial arteries to intracranial venous sinuses or veins. DAVFs may lead to cortical venous reflux with supraphysiological flow and may subsequently rupture causing intracerebral, subarachnoidal, or subdural hemorrhages. Stereotactic radiosurgery (SRS) represents a valid option for selected DAVF cases. Overall, SRS leads to complete occlusion of the DAVF in approximately 60% of cases, (range 40–95%), at a follow-up ranging from 1 to 5 years.

Indications for SRS in the treatment of DAVFs are prevention of intracranial hemorrhage from DAVFs with cortical venous reflux and relieving intolerable tinnitus. However, unlike endovascular or microsurgical occlusion of DAVFs that provide immediate therapeutic effect, the therapeutic effect of SRS on the DAVFs comes with a delay ranging from several months to several years, subsequently exposing the patient to hemorrhage. Therefore, SRS should not be considered as the treatment of choice for ruptured DAVFs unless endovascular or microsurgical occlusion is unfeasible or markedly risky. The optimal margin dose is 18–20 Gy given in one single fraction, but this should be adapted to DAVF volume and location. In DAVFs with a volume larger than 10 cm3, we have considered fractionated SRS with a schedule of 5Gy/fraction × 6 fractions or volume staging in which subvolumes of the DAVF are treated with a single fraction of 20–18Gy sequentially. In large DAVFs, pretreatment downsizing of the DAVF with embolization or partial DAVF treatment followed by embolization of the residual malformation can be also considered.

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Authors and Affiliations

  1. Department of Neurosurgery, Tampere University Hospital, Tampere, Finland

    Juhana Frösen

  2. Department of Neurosurgery, Kuopio University Hospital, Kuopio, Finland

    Antti Lindgren

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  1. Juhana Frösen
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Correspondence to Juhana Frösen .

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Editors and Affiliations

  1. Associate Professor of Neurosurgery, Alma Mater Studiorum University of Bologna, Bologna, Italy

    Alfredo Conti

  2. Scientific Director, AB Medica, Milano, Italy

    Pantaleo Romanelli

  3. Assistant Professor, Medical Physics Laboratory, Medical School, National and Kapodistrian University of Athens, Athens, Greece

    Evangelos Pantelis

  4. Associate Professor, Department of Radiation Oncology, Stanford University Cancer Center, Stanford, CA, USA

    Scott G. Soltys

  5. Associate Professor, Department of Neurosurgery and Radiosurgery Center, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea (Republic of)

    Young Hyun Cho

  6. Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Michael Lim

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Frösen, J., Lindgren, A. (2020). Dural Arteriovenous Fistulas. In: Conti, A., Romanelli, P., Pantelis, E., Soltys, S., Cho, Y., Lim, M. (eds) CyberKnife NeuroRadiosurgery . Springer, Cham. https://doi.org/10.1007/978-3-030-50668-1_45

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