OBJECTIVE Stereotactic radiosurgery (SRS) has emerged as a safe and effective treatment modality for dural arteriovenous fistulas (dAVFs), particularly cavernous sinus (CS) dAVFs. However, the long-term outcomes of non-CS dAVFs are not well known. This study aimed to evaluate the efficacy and safety of SRS for non-CS dAVFs and to investigate the risk factors for incomplete obliteration. METHODS Between 2007 and 2020, 65 non-CS dAVFs in 63 patients were treated using SRS at a single institution. Demographic characteristics, initial clinical presentations, clinical outcomes, and radiological findings were retrospectively reviewed. The procedure-related complications were assessed. Radiological outcomes were evaluated as complete obliteration, incomplete obliteration, and angiographic worsening, whereas clinical outcomes were evaluated for symptom recovery. RESULTS At a median follow-up of 17 months, the overall complete obliteration rate was 63.1%, and the cumulative obliteration rates were 24.6%, 60.0%, 70.0%, and 74.3% at 12, 24, 36, and 48 months, respectively. Six patients underwent retreatment due to angiographic worsening; in 5 of these patients, recruitment of arterial feeders was newly observed in the adjacent sinus, which was not treated in the initial SRS. In the multivariate analysis, high-flow shunt and venous ectasia were associated with incomplete obliteration. No adverse events occurred after SRS. CONCLUSIONS SRS for non-CS dAVFs is safe, and its efficacy is highly variable according to location. High-flow shunts may indicate greater radioresistance. In the retreated cases, new fistulas tended to be accompanied by sinus steno-occlusion and formed in the adjacent sinus segments.

中文翻译：

---

非海绵窦硬脑膜动静脉瘘的立体定向放射外科治疗：治疗结果及其预测因素。

目的 立体定向放射外科 (SRS) 已成为治疗硬脑膜动静脉瘘 (dAVF)，特别是海绵窦 (CS) dAVF 的安全有效的治疗方式。然而，非 CS dAVF 的长期结果尚不清楚。本研究旨在评估 SRS 对非 CS dAVF 的疗效和安全性，并调查不完全闭塞的危险因素。方法 2007 年至 2020 年间，63 名患者的 65 例非 CS dAVF 在同一机构接受了 SRS 治疗。对人口学特征、初始临床表现、临床结果和放射学结果进行回顾性审查。评估了与手术相关的并发症。放射学结果评估为完全闭塞、不完全闭塞和血管造影恶化，而临床结果评估为症状恢复。结果 中位随访 17 个月时，总体完全闭塞率为 63.1%，12、24、36 和 48 个月的累积闭塞率分别为 24.6%、60.0%、70.0% 和 74.3% 。六名患者因血管造影恶化而接受再治疗；在其中 5 名患者中，在最初的 SRS 中未进行治疗的相邻窦中新观察到动脉供血血管的募集。在多变量分析中，高流量分流和静脉扩张与不完全闭塞相关。SRS 后没有发生不良事件。结论 对于非 CS dAVF 进行 SRS 是安全的，其疗效根据部位的不同而有很大差异。高流量分流可能表明放射抗性更大。在复治病例中，新的瘘管往往伴有窦狭窄闭塞，并在邻近的窦段形成。