[Radiosurgery for intracranial dural arteriovenous fistulas--indications for limitations for gamma knife treatment].

: We summarize the results of gamma knife treatment for dural arterivenous fistula (DAVF), are report our study. Since the early 1990s, DAVFs have been treated in the same manner as arteriovenous malformations (AVMs), i.e., by radiosurgery, performed with or without embolization. DAVFs in the cavernous sinus, transverse-sigmoid sinus, and cerebellar tent were treated with a marginal dose of 18 to 20 Gy. The current obliteration rates of DAVF reported in literature are not low when compared with those of AVM. Excellent DAVF obliteration rates were observed in our study, which were similar to those reported in the literature. In fact, complete response (CR) was observed in 9 cases, partial response (PR) in 9 cases, and partical obliteration in 6 cases during the mean follow-up of 27 months. Moreover, considerable neurological improvements were noted, which apparently began at an early stage post radiosurgery. Bleeding was observed 2 cases associated with cortical reflux during the follow-up. In conclusion, radiosurgery for DAVF is very useful for both the obliteration of the fistula and for the improvement of clinical signs. However, prior to performing radiosurgery, the lesions with cortical reflux should be interrupted by initially treated with surgery or embolization.