Neurosurgery 97:1368–1376, 2025
This single-center retrospective study evaluates long-term late radiation-induced complications (LRICs) after stereotactic radiosurgery (SRS) for dural arteriovenous fistulas (DAVFs) in 30 patients over a median 99-month follow-up, reporting obliteration rates, post-SRS T2 signal changes, and incidence of chronic encapsulated hematoma (CEH). Findings show high DAVF obliteration (79.6% at 5 years) with rare but notable LRICs (11.1% at 10 years), and an association between post-SRS signal changes and CEH occurrence.
The report details radiosurgical techniques, diagnostic criteria, case courses of two asymptomatic CEHs managed conservatively, and discusses pathophysiology linking radiation, VEGF-mediated permeability, and lesion expansion. The authors recommend prolonged imaging surveillance, heightened monitoring for patients with post-SRS T2 changes, and call for larger multicenter studies to refine predictive models and management strategies.
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