Development and further refinements of endovascular techniques and stereotactic radiosurgery have changed the treatment paradigm of intracranial dural arteriovenous fistulas (DAVFs).

     We describe decision-making, results and complications in a prospective contemporary series.

     Sixty consecutive patients evaluated for DAVFs at our institution since 2008 were included in a prospective database.

     Data collected include patient demographics, presenting symptoms and signs, angioarchitecture, treatment recommendations, clinical outcomes, complications, and radiological follow-up.

     Thirty-five patients underwent endovascular embolization as the primary treatment: transvenous embolization (TVE) was used in 15 patients with complete obliteration in 93% of cases; Onyx embolization was used in 17 patients with complete obliteration in 82%; and transarterial particle embolization (TAE) was used alone in 3 patients without success. Six patients underwent surgical excision after failed embolization with 83% completely obliterated. Fourteen patients were treated with Gamma Knife radiosurgery. Observation was recommended in 12 patients. Complete resolution or significant improvement of symptoms was seen in: 85% of patients treated with TVE; 87% of Onyx cases, 33% treated with TAE alone; 75% of surgical cases; and 80% of Gamma Knife patients. There was no mortality and no permanent neurological sequelae. One patient suffered a transient seventh nerve palsy after TAE, while another patient suffered an access complication (groin hematoma). No adverse radiation complications were identified in Gamma Knife patients.

     This is a retrospective study.

     A treatment strategy utilizing different treatment modalities and techniques alone or in combination based on clinical and angiographic features is highly effective and safe in the modern management of intracranial DAVFs.