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Case series
Sacral dural arteriovenous fistulas: a diagnostic and therapeutic challenge – single-centre experience of 13 cases and review of the literature
  1. Andrea Gioppo1,2,
  2. Giuseppe Faragò1,
  3. Caterina Giannitto3,
  4. Luigi Caputi4,
  5. Andrea Saladino5,
  6. Francesco Acerbi6,
  7. Elisa Ciceri1,7
  1. 1 Department of Interventional Neuroradiology, IRCCS Foundation Neurological Institute ’C. Besta', Milano, Italy
  2. 2 Università degli Studi di Milano, Postgraduation School in Radiodiagnostics, Milano, Italy
  3. 3 Department of Radiology, European Institute of Oncology, Milano, Italy
  4. 4 Cerebrovascular Unit, IRCCS Foundation Neurological Institute ’C. Besta', Milano, Italy
  5. 5 Department of Neurosurgery 1, IRCCS Foundation Neurological Institute ’C. Besta', Milano, Italy
  6. 6 Department of Neurosurgery 2, IRCCS Foundation Neurological Institute ’C. Besta', Milano, Italy
  7. 7 Department of Neuroradiology, Azienda Ospedaliera Universitaria Integrata Borgo Trento, Verona, Italy
  1. Correspondence to Dr Giuseppe Faragò, Department of Interventional Neuroradiology, IRCCS Foundation Neurological Institute “C. Besta”, Milano, Italy; giuseppe.farago{at}


Background Sacral dural arteriovenous fistulas (DAVFs) are rare vascular abnormalities of the spine characterised by slowly progressive symptoms that can mimic different myelopathy disorders.

Object To report our single Institution experience with sacral DAVFs.

Methods We retrospectively reviewed the clinical records of patients admitted from 1 January 2006 to 31 December 2016 with a diagnosis of sacral DAVFs, treated by endovascular embolisation or surgical clipping. Clinical presentation, imaging characteristics, treatment results and follow-up were analysed.

Results We identify 13 patients with sacral DAVFs supplied by lateral sacral arteries. Clinical presentation was characterised by different degrees of motor weakness and sphincter disturbances. In all patients, spinal MRI showed spinal cord hyperintensities with enhancement and prominent perimedullary vessels. Selective internal iliac angiography was mandatory to identify the exact location of the fistula. A complete embolisation was achieved in eight patients performing a single endovascular embolisation and in three patients performing a single surgical disconnection: two patients required combined procedures. Follow-up imaging showed a complete resolution of the spinal cord hyperintensities in 81% of patients and a reduction of the intramedullary enhancement in 91%. Gait improvement was observed in 73% of patients, while remaining stable in 27%. Sphincter disturbances improved in 36% of patients and remained stable in 64%.

Conclusion Awareness of sacral location of DAVFs is critical because standard spinal angiography will not identify sacral supplies, unless internal iliac arteries are properly examined. In our experience, the endovascular treatment show results comparable to surgery when the fistula point is correctly disconnected.

  • spine
  • lumbosacral
  • subdural
  • fistula

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  • Contributors All authors made substantial contributions to the conception or design of the work: or the acquisition, analysis, or interpretation of data for the work; drafted the work or revised it critically for important intellectual content; and provided final approval of the version to be published; and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval IRCCS Foundation Neurological Institute ’C. Besta' Ethical Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.