Successful Management of Sacral Dural Arteriovenous Fistulas: A Case Series and Literature Review.

BACKGROUND:Spinal dural arteriovenous fistula (DAVF) occurs at any spinal level; however, a sacral location of fistula is extremely rare, and the clinical characteristics of sacral DAVF have not been well described. This study aimed to document the clinical features of sacral DAVF and review the existing literature. CASE DESCRIPTION:The first patient was a 55-year-old man who had progressive weakness and numbness in his lower extremities, along with mild urinary incontinence. The second case was a 32-year-old man who had a 1-year history of progressively worsening bilateral lower extremity weakness associated with diminished sensation. The third patient was a 43-year-old woman with 6-month history of progressive motor weakness of her lower limbs. On spinal angiography, a sacral DAVF with perimedullary vein drainage in all cases was observed. The sacral fistulas were completely obliterated with surgical intervention, and the symptoms of these patients have been gradually resolved. Follow-up magnetic resonance imaging showed complete or partial resolution of the edema within the spinal cord and disappearance of the abnormal vascular flow voids. CONCLUSIONS:Sacral DAVFs are extremely rare and are easily missed by spinal angiography. Clinicians should be aware of the possibility of the occurrence of sacral DAVFs, and spinal angiography for the complete assessment of spinal vasculature should be carried out.