• Hardik Sardana, Deepak Agrawal, Bhavya Pahwa, Man Mohan Singh, Nalin K Mishra, and Shashank S Kale.
• Department of Neurosurgery and Gamma Knife, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.
• World Neurosurg. 2022 Feb 1; 158: e922-e928.

ObjectiveTo evaluate the clinical and radiological outcome of Gamma Knife radiosurgery (GKS) in treatment of intracranial dural arteriovenous fistula (DAVF) with cortical venous drainage (CVD) and compare it with the outcome of endovascular therapy.MethodsPatients who underwent GKS or endovascular therapy for intracranial DAVF with CVD over 10 years (January 2007 to December 2016) at the All India Institute of Medical Sciences, New Delhi, were included. Demographics, clinical presentation, imaging details, and follow-up clinical status were reviewed retrospectively. Clinical follow-up was conducted once every 6 months. Radiological follow-up using digital subtraction angiography was performed at a mean 24 months after intervention. Patients with clinical follow-up of <1 year were excluded from the study.ResultsThe study included 35 patients (26 in 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% of 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). GKS was at least as effective as embolization in terms of clinical and radiological outcome in treatment of intracranial DAVF with CVD.ConclusionsContrary to popular perception, GKS should be considered as an effective first-line treatment alternative of intracranial DAVF with CVD.Copyright © 2021 Elsevier Inc. All rights reserved.

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