Embolization of Sacral Dural Arteriovenous Fistulas: A Case Series and Literature Review

Abstract

The authors report 2 cases of sacral dural arteriovenous fistula (AVF) presenting with gradual neurologic decline characterized by progressive lower extremity weakness and bowel and bladder incontinence. Spinal angiography demonstrated a sacral dural AVF with perimedullary vein engorgement and drainage extending to the level of the cervical spine in both cases. The fistulas were completely obliterated with n-BCA (n-butyl cyanoacrylate) embolic agent in one case, and with ethylene vinyl alcohol (Onyx) in the second, resulting in improvement of the symptoms in both patients. The unique features of this case report include the rare location of the fistula's origin, the necessity for complete spinal angiography, and the use of intraoperative monitoring in one case to guide embolization treatment.

Acquired lumbosacral spinal dural arteriovenous fistula in association with degenerative lumbosacral disc herniation and spinal canal stenosis: Report of two cases and review of the literature

“…The collected data in this review include demographic data (i.e., gender and age of patient), symptoms and signs, level of disc herniation and/or spinal canal stenosis, previous history of spinal surgery, location and artery supply of the fistulas, treatment, and neurological outcome of the patients [ Table 1 ]. [ 8 16 17 18 19 20 22 23 26 ] From the literature review, there were 11 cases including our two cases. All patients were male with a median age of 54 years, range 27–79 years.…”

“…In our literature review, seven patients, including our two cases, had preexistent fistulas coexisting with degenerative lumbosacral spondylosis. [ 8 19 22 23 26 ] Stevens et al . [ 22 ] reported a middle-aged male with a preexistent, asymptomatic SDAVF that became acutely symptomatic after lumbar discectomy.…”

“…Alvarado et al . [ 26 ] reported sacral DAVF in a 69-year-old male presenting with long-standing low back pain and acute exacerbation of myelopathy 2 years before presentation. MRI of the lumbosacral spine clearly demonstrated severe spinal canal stenosis L3-5.…”

“…SDAVFs can be treated by surgery, endovascular treatment, or combined approach depends on institutions preference. [ 4 5 13 18 26 ] The goal of treatment of SDAVF is to obliterate the fistula, including the proximal portion of the draining vein, without excision of the dilated venous plexus. [ 6 ] Endovascular treatment has a chance of recanalization or recurrence of the fistula more than surgery.…”

A Rare and Treatable Cause of Medullar Claudication: Spinal Dural Arteriovenous Fistula

“…Endovascular treatment can be performed by using a liquid agent (glue) to embolize the fistula point. 4 In cases of contraindication or failure of embolization, surgical treatment should be discussed and performed as quickly as possible by using a clip or by coagulating the vein implicated in the arteriovenous shunt. The success rate of surgical treatment is higher than that of embolization (98% vs 46%).…”