Predicting Outcomes of Stereotactic Radiosurgery for Dural Arteriovenous Fistulas

Stereotaxic radiosurgery (SRS) is an important alternative, additive or salvage intervention for the treatment of dural arteriovenous fistulas (dAVF). Treatment with SRS can offer favorable rates of dAVF obliteration and offers a solution to dAVF not amenable or refractory to surgical or endovascular treatment. It is important to identify the factors associated with favorable outcomes following SRS. Recent studies suggest that anatomic location, angiographic and clinical criteria can affect the outcome of SRS. Established grading scales based on angiographic criteria are primarily focused on hemorrhage risk stratification and provide guidance regarding management but do not adequately predict effectiveness of SRS. The primary goal of this chapter is to outline the factors that predict dAVF obliteration as described in recent studies. We also describe a practical grading system by Nasser et al. that incorporates angiographic, anatomic and clinical parameters to specifically predict dAVF outcomes following SRS. Our goal is to help clinicians predict SRS outcomes on an individual basis and as such aid the decision-making process.