Sacral CSF-venous fistula diagnosed using single-day bilateral decubitus myelography: A rare case and a novel technical modification

CSF-venous fistulas are a common cause of spontaneous intracranial hypotension, a disease that can cause debilitating orthostatic headaches and a wide range of other symptoms. The vast majority of CSF-venous fistulas occur in the thoracic spine. Sacral CSF-venous fistulas are exceptionally rare but have been reported. While all CSF-venous fistulas require decubitus myelography with special modifications for detection, sacral CSF-venous fistulas can be particularly challenging to detect. Here, we describe a patient with a right S2 CSF-venous fistula. Additionally, we detail the specific myelographic technique that was necessary to detect this fistula. The case provides unique insights into a challenging radiologic diagnosis.