Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China.
Department of Neurosurgery, West China/Shangjin Nanfu Hospital, Sichuan University, Chengdu, Sichuan, PR China.
World Neurosurg. 2019 Jun;126:164-170. doi: 10.1016/j.wneu.2019.02.129. Epub 2019 Mar 4.
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.
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.
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.
脊髓动静脉瘘（DAVF）可发生于任何脊髓节段；然而，瘘位于骶骨的情况极为罕见，且骶骨 DAVF 的临床特征尚未得到充分描述。本研究旨在记录骶骨 DAVF 的临床特征并复习现有文献。
第一个患者是一名 55 岁男性，逐渐出现下肢无力和麻木，伴有轻度尿失禁。第二个病例是一名 32 岁男性，有 1 年的双侧下肢进行性无力伴感觉减退病史。第三个患者是一名 43 岁女性，有 6 个月的下肢进行性运动无力病史。脊髓血管造影显示所有患者均存在骶骨 DAVF 伴髓周静脉引流。通过手术干预完全闭塞骶骨瘘，这些患者的症状逐渐缓解。随访磁共振成像显示脊髓内水肿完全或部分消退，异常血管流空消失。
骶骨 DAVF 极为罕见，易被脊髓血管造影漏诊。临床医生应意识到骶骨 DAVF 发生的可能性，应进行脊髓血管造影以全面评估脊髓血管。
