Intracranial Dural Arteriovenous Fistulas with Cortical Venous Drainage: Radiosurgery as an effective alternative treatment.

Abstract Aim Our aim was to evaluate the clinical and radiological outcome of Gamma knife radiosurgery (GKS) in the treatment of intracranial dural arteriovenous fistula (DAVF) with cortical venous drainage (CVD) and compare it with the outcome of endovascular therapy. Methodology This series includes patients who underwent GKS or endovascular therapy for intracranial DAVF with CVD over 10 years (Jan 2007 to Dec 2016) at the All India Institute of Medical Sciences, New Delhi. Their demographic profile, clinical presentation, imaging details, and follow up clinical status were reviewed retrospectively. Clinical follow up was done once every 6 months. Radiological follow up using digital subtraction angiography (DSA) was performed at a mean duration of 24 months post intervention. Patients who had a clinical follow up of less than 1 year were excluded from the study. Results 35 patients (26 in the embolization group and 9 in GKS group) who had intracranial DAVF with CVD were included in the study. Clinical improvement was seen in 77.78% of the patients who received GKS and 57.7% in the patients who underwent embolization (p = 0.431). Complete obliteration of DAVF was seen in 55.56% of the patients in the GKS group and 57.7% of the patients in the embolization group (p = 1). Our study shows that GKS is at least as effective as embolization in terms of clinical and radiological outcome in the treatment of intracranial DAVF with CVD. Conclusion Contrary to popular perception, GKS should be considered as an effective first line treatment alternative of intracranial DAVF with CVD.