鉴于这种病变的罕见性和治疗模式的多样性，立体定向放射外科 (SRS) 在颅内硬脑膜动静脉瘘 (dAVF) 治疗中的作用尚不清楚。本研究描述了 30 年的 SRS 技术经验及其对 dAVF 患者的结果。作者对 1990 年至 2021 年间接受过单次 SRS 的 dAVF 患者进行了回顾性分析。最初使用的成像方式靶向治疗是单独血管造影，然后是血管造影加 MRI，最近是单独 MRI。 222 名患者接受了单独 SRS 治疗（n = 56，25%）或 SRS 加栓塞治疗（n = 166，75%），具体取决于症状的严重程度或是否存在皮质静脉引流（CVD）。大多数患者为女性 (64%)，患者中位年龄为 60 岁。常见症状为搏动性杂音（55%）、视力改变或水肿（21%）、头痛（10%）和脑出血（5%）。最常见的 dAVF 位置是横窦或乙状窦 (44%)，其次是海绵窦 (24%)、颈静脉球 (9%) 和圆窦 (5%)。 28% 的病例出现 CVD，5% 的病例出现静脉扩张。患者中 Borden dAVF 类型为 I (72%)、II (20%) 和 III (8%)。患者中的 Cognad dAVF 类型为 I (44%)、IIa (27%)、IIb (5%)、IIa b (15%)、III (4%) 和 IV (5%)。中位 SRS 治疗体积为 7.6 cm3；中位边缘和最大剂量分别为 18 和 36 Gy。 209 名患者在 SRS 后进行了随访（中位随访时间为 31 个月）。随访血管成像发现 75% 的患者 (110/147) 出现闭塞；中位消失时间为 37 个月。多变量分析显示，海绵窦 dAVF 位置可预测放射学闭塞（HR 1.86，95% CI 1.08-3.18，p = 0.024）。在非海绵窦 dAVF 亚组分析中，不存在 CVD 可预测闭塞（HR 0.53，95% CI 0.29-0.98，p = 0.04）。经过临床随访，86% (160/185) 的患者症状得到缓解。 12 名患者 (5.4%) 出现与 SRS 计划血管造影相关的并发症 (n = 2, 0.9%)、栓塞 (n = 3, 1.4%)、SRS 后出血 (n = 1, 0.5%)、迟发性窦血栓形成 (n = 1, 0.5%) n = 1, 0.5%)、放射诱发的肿瘤 (n = 2, 0.9%) 和慢性包裹性扩张血肿 (n = 3, 1.4%)。单独 SRS 或与栓塞联合使用可以为大多数患者提供消除和症状缓解dAVF 患者的手术相关发病率较低。患者面临晚期放射相关并发症的风险，可能需要在 SRS 术后多年进行治疗。

The role of stereotactic radiosurgery (SRS) in the management of intracranial dural arteriovenous fistula (dAVF) is unclear given the rarity of this lesion and the variability in treatment paradigms. This study describes a 3-decade experience with the SRS technique and its outcomes for patients with dAVF.The authors conducted a retrospective analysis of patients with dAVF who had undergone single-fraction SRS in the period from 1990 to 2021. The imaging modality initially used for targeting was angiography alone, then angiography plus MRI, and most recently MRI alone.Two hundred twenty-two patients underwent SRS alone (n = 56, 25%) or SRS plus embolization (n = 166, 75%), depending on the severity of symptoms or the presence of cortical venous drainage (CVD). Most patients were women (64%), and the median patient age was 60 years. Common presenting symptoms were pulsatile bruit (55%), visual change or chemosis (21%), headache (10%), and intracerebral hemorrhage (5%). The most frequent dAVF location was the transverse or sigmoid sinus (44%), followed by the cavernous sinus (24%), jugular bulb (9%), and torcula (5%). CVD was noted in 28% of cases, and venous ectasia in 5%. Borden dAVF types among the patients were I (72%), II (20%), and III (8%). Cognard dAVF types among the patients were I (44%), IIa (27%), IIb (5%), IIa+b (15%), III (4%), and IV (5%). The median SRS treatment volume was 7.6 cm3; the median margin and maximum doses were 18 and 36 Gy, respectively. Follow-up after SRS was available for 209 patients (median follow-up 31 months). Obliteration was noted in 75% of the patients (110/147) with follow-up vascular imaging; the median time to obliteration was 37 months. Multivariate analysis revealed that a cavernous sinus dAVF location was predictive of radiological obliteration (HR 1.86, 95% CI 1.08-3.18, p = 0.024). The absence of CVD was predictive of obliteration in subgroup analysis of non-cavernous sinus dAVF (HR 0.53, 95% CI 0.29-0.98, p = 0.04). Symptoms resolved in 86% of patients (160/185) with clinical follow-up. Twelve patients (5.4%) had complications related to angiography for SRS planning (n = 2, 0.9%), embolization (n = 3, 1.4%), post-SRS hemorrhage (n = 1, 0.5%), delayed sinus thrombosis (n = 1, 0.5%), radiation-induced tumors (n = 2, 0.9%), and chronic encapsulated expanding hematoma (n = 3, 1.4%).SRS alone or in conjunction with embolization provided obliteration and symptom relief for the majority of patients with dAVF, with a low rate of procedure-related morbidity. Patients are at risk for late radiation-related complications, which can require treatment many years after SRS.