SRS could be a safe and effective treatment option for selected Borden type III DAVFs utilized as primary treatment for low-flow shunts or as adjuvant treatment for remnant/recurrent shunts, when other treatment modalities are not indicated.
Complete fistula obliteration was achieved in 76.5% of patients treated with SRS for Borden type III DAVFs.
There was no statistically significant difference in obliteration rates between primary SRS and adjuvant SRS after prior endovascular treatment or surgery.
SRS for Borden type III DAVFs resulted in no post-SRS hemorrhage and no radiation-induced complications.
DAVF-related symptoms improved in the majority of patients with symptomatic presentation.
The study cohort consisted of patients with a median age of 65 years, with hemorrhagic-onset patients predominantly receiving prior interventional treatment before SRS.
This research suggests that stereotactic radiosurgery (SRS) — a precise, non-invasive form of radiation treatment — can be both safe and effective for a specific category of abnormal blood vessel connections in the brain called Borden type III dural arteriovenous fistulas (DAVFs). These are considered among the more complex and higher-risk types because blood drains directly into the brain's veins, potentially raising the risk of bleeding or neurological problems. The study followed 17 patients over a median of 30 months and found that about 77% achieved complete closure of the abnormal connection, with no cases of post-treatment bleeding or radiation-related side effects. The study found that SRS worked comparably whether it was used as the first treatment (in patients with lower-risk, low-flow fistulas) or as a follow-up treatment after other interventions like endovascular therapy or surgery had not fully resolved the condition. Among patients who had noticeable symptoms from their DAVF, 83% showed improvement after SRS. The radiation dose used was typically 18 Gray, and obliteration rates continued to improve over time, reaching about 76% at five years. This research matters because Borden type III DAVFs are challenging to treat, and not all patients are suitable candidates for surgery or catheter-based procedures. This study suggests that SRS may offer a viable and low-risk alternative or complementary approach in carefully selected patients, though the small sample size (17 patients) and retrospective design mean these findings should be interpreted cautiously and confirmed in larger studies.
Hirata T, Umekawa M, Shinya Y, Hasegawa H, Koizumi S, Katano A, et al.. (2026). Safety and efficacy of stereotactic radiosurgery for selected borden type III dural arteriovenous fistulas.. Neurosurgical review. https://doi.org/10.1007/s10143-026-04350-6