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Thirteen consecutive patients were diagnosed with deep lumbosacral spinal dural arteriovenous fistula at a single center between 2006 and 2018. Paraparesis was present in 12 (92%) patients. Sphincter dysfunction and sensory symptoms were observed in 7 (54%) and 6 (46%) patients, respectively. The mean duration of symptoms was 6 ± 8 months. Congestive myelopathy on MR imaging was present in all patients. Prominent arterialized perimedullary veins were demonstrated in only 3 cases. Time-resolved contrast-enhanced dynamic MRA revealed arterialized perimedullary veins and an arterialized ventrolateral epidural pouch in 9/10 (90%) patients, mostly located ventrolaterally. The authors conclude that time-resolved contrast-enhanced dynamic MRA is a powerful diagnostic tool for identifying arterialized perimedullary veins as well as an arterialized ventrolateral epidural pouch.