Gamma Knife radiosurgical treatment of a dural arteriovenous fistula with the feeding branches from the meningo-pituitary trunks of both internal carotid arteries

Treatment strategies for dural arterio-venous fistulas (DAFs) include single or multimodal schemes, including microsurgery, endovascular transarterial or transvenous embolization, or stereotactic radiosurgery (SRS). In the scientific medical resources, only 9 cases of bilateral DAFs of the brain are described, which required surgical intervention, and 4 were treated with endovascular or microsurgical approach; SRS was used in 5 cases, of which in 4 cases with previous or subsequent endovascular embolization. We have presented a case of successful SRS with Gamma Knife of bilateral DAF from the branches of meningo-hypophyseal trunks from inner carotid arteries without preliminary embolization or surgical resection. The use of SRS with Gamma Knife is possible with low-flow DAFs, as well as a part of a multimodal strategy with high-flow DAFs, which requires further study.