Search

Objective To investigate the clinical and imaging features as well as surgical treatment outcomes of sacral dural arteriovenous fistulas (DAVFs), in order to improve the understanding and proper management of the disease. Methods The clinical data of 15 patients with sacral DAVFs admitted to Department of Neurosurgery, West China Hospital, Sichuan University from January 2018 to January 2023 were analyzed retrospectively. All patients underwent magnetic resonance imaging (MRI) examination of the spinal cord before the operation, and all patients underwent spinal angiography for proper diagnosis. Surgical resection or interventional embolization were used for treatment. Results The main clinical symptoms were weakness of both lower limbs in 14 cases (93%), limb sensory disturbance in 12(80%), urinary and bowel dysfunction in 13(86%), and lumbar or lower limb pain in 2(13%). All patients underwent spinal cord angiography (including bilateral internal iliac arteries) to confirm the diagnosis. The fistulas were located at the L5-S3 level. Surgical treatment was performed in 12 cases and interventional embolization in 3. The patients were followed up for 6 to 60 months (mean 26. 2 months). The symptoms were improved in 13 cases (86%). Two patients (14%) were stable, and no patients had worsening symptoms. No residual or recurrence was found in all patients by postoperative imaging examination. Conclusions Sacral DAVFs are rare in clinical practice. Selective spinal angiography must include bilateral intermal iliac arteries to find the fistulas. The presence of dilated filum terminale veins (FTV) in the lumbosacral spinal canal on preoperative MRI is an important basis for further diagnosis of sacral DAVF, Both surgery and interventional therapy are effective for the treatment of sacral DAVFs. [ABSTRACT FROM AUTHOR]