Microsurgical treatment of sacral spinal dural arteriovenous fistula

Sacral spinal dural arteriovenous fistulas (dAVFs) are rare vascular lesions. In this video, the authors describe the case of a 71-year-old female who presented with profound myelopathy secondary to a sacral spinal dAVF. Identification of these lesions requires a high index of clinical suspicion, and a complete spinal angiography study including evaluation of the pelvic vasculature is necessary to detect the arteriovenous shunting. The video demonstrates a nuanced approach to angiographic detection of the dAVF and identification of the fistulous point at the left S1-2 neural foramen, and subsequent treatment with microsurgical selective venous disconnection. The video can be found here: https://stream.cadmore.media/r10.3171/2025.7.FOCVID25112.