Clinical and radiological response of benign dural arteriovenous fistulas after stereotactic radiotherapy.

Background: Dural arteriovenous fistulas (DAVFs) are abnormal connections between dural arteries and venous sinuses or veins, commonly occurring at the transverse-sigmoid sinus. This study evaluates the clinical and radiological outcomes of benign DAVFs treated with hypofractionated stereotactic radiotherapy (HSRT). Methods: A retrospective review was conducted to assess the clinical and radiological responses of patients with benign DAVFs who underwent HSRT at a single center from January 2015 to December 2022. Results: A total of 242 patients with DAVFs were treated, of which 115 patients underwent endovascular treatment. Eight patients who were diagnosed with benign DAVFs (75% females and 25% males), predominantly located in the transverse-sigmoid sinus, were treated with HSRT from January 2015 to December 2022. The cohort had an average age of 52.75 years. All patients presented with pulsatile tinnitus, with one also experiencing headaches. Complete symptomatic recovery was observed in 75% of patients within a mean of 9.7 months' post-HSRT. Partial recovery was reported in 25% of patients. Radiographic obliteration was achieved in 85.7% of patients within a mean of 22.3 months, with one patient exhibiting stable disease. Focal alopecia and hyperintense changes on imaging were reported as transient side effects. Conclusion: HSRT provides effective and safe treatment with high rates of symptomatic recovery and radiological obliteration in benign DAVFs at the transverse-sigmoid sinus. This method provides an attractive, minimally invasive treatment option for these patients who suffer from pulsatile tinnitus.