Factors associated with favorable outcome following stereotactic radiosurgery (SRS) for dural arteriovenous fistulas (DAVFs) with cortical venous reflux (CVR) are incompletely understood. The aim of this retrospective cohort study is to assess the outcomes after SRS for high-grade DAVFs and identify predictors.
We performed a retrospective review of consecutive patients with high-grade DAVFs, defined as the presence of CVR, who underwent SRS between 1989 and 2017. The primary outcome was defined as DAVF obliteration without a new permanent neurological deficit. Predictors of outcomes were determined using multivariate logistic regression.
The study cohort comprised 41 high-grade DAVF patients with a mean age of 52 years. DAVF obliteration without a new permanent neurological was achieved in 62% (13/21 patients). The rates of complete obliteration and new permanent neurological deficit were 63% (17/27 patients) and 23% (7/30 patients), respectively. No independent predictors of the primary outcome or angiographic obliteration were identified in the multivariate model. Presentation with a non-hemorrhagic neurological deficit (NHND) was found to be an independent predictor of a new permanent neurological deficit after SRS (OR=14.176 [1.119 - 179.540], p=0.041).
Obliteration without a new permanent neurological deficit can be achieved in the majority of appropriately selected patients with high-grade DAVFs after treatment with SRS. NHND at presentation is a risk factor for new permanent neurological deficits after SRS.
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