The Bilateral Sacral Origin of a Spinal Dural Arteriovenous Fistula: A Case Report

Spinal dural arteriovenous fistulas (SDAVFs) are characterized by an abnormal connection between a spinal radicular artery and a perimedullary vein, mainly fed by a radicular artery at the nerve root sleeve. Here, we describe the case of a 40-year-old woman, presenting with progressive weakness of the lower extremities and the sphincter. Thoracic magnetic resonance imaging (MRI) showed spinal cord edema and signal voids on the dorsal surface of the cord. Spinal angiography demonstrated a SDAVF with a nidus at the sacral level; the feeder of the arteriovenous fistula was a lateral sacral artery, as a branch of the internal iliac artery. The lateral sacral artery was subselectively catheterized, and SDAVF was embolized with 25% n-butyl cyanoacrylate (NBCA) glue (glue: lipiodol ratio, 1:3). After embolization, no definite residual connection was visualized between the arterial and venous systems.