Endovascular management of spinal vascular malformations: history and literature review

Medel, Ricky; Crowley, R. Webster; Dumont, Aaron S.

doi:10.3171/foc.2009.26.1.e7

Cited by 25 publications

(17 citation statements)

References 57 publications

(89 reference statements)

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“…Aneurysm formations are seen in about 20%–40% of these lesions 2. Typically presenting in children, glomus-type AVMs produce considerable morbidity, often leading to neurological deficits 3.…”

Section: Discussionmentioning

confidence: 99%

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Improved neurological function in a paediatric patient following Onyx embolization of a cervical glomus arteriovenous malformation

Kitamura

Jacobson

Zouros

et al. 2010

J NeuroIntervent Surg

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Spinal cord intramedullary arteriovenous malformations (AVMs) pose a therapeutic challenge. Because of their complex angioanatomy, surgical excision of these lesions is difficult at best. Over the past decade, endovascular therapy has been established as an alternative treatment modality. As an embolic agent, N-butyl cyanoacrylate (NBCA) posed several problems such as difficulty of use and unpredictable performance. Onyx (ev3, Irvine, California, USA), an alternative liquid embolic agent, possesses several advantageous properties, such as increased control of agent delivery, over previous embolic agents like NBCA. However, reports of Onyx use in treating spinal intramedullary AVMs are still rare, especially in paediatric patients. We report a paediatric patient with glomus-type spinal intramedullary AVM treated successfully with Onyx with intermediate-term outcome.

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Section: Discussionmentioning

confidence: 99%

“…Many current classification systems of spinal cord vascular malformation divide lesions based on distinct biological characteristics (table 1). 1 2…”

Section: Introductionmentioning

confidence: 99%

Improved neurological function in a paediatric patient following Onyx embolization of a cervical glomus arteriovenous malformation

Kitamura

Jacobson

Zouros

et al. 2010

J NeuroIntervent Surg

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“…7,14,15,17 According to a meta-analysis, the rate of occlusion after initial treatment with endovascular embolization has not yet reached that of open microsurgery; moreover, the lasting effectiveness of open microsurgery is significantly superior to that of endovascular embolization because dural AVF recurrence has been more commonly reported after endovascular treatment. The success rate of permanent AVF occlusion was previously reported to be 98% for open surgery and 10%-75% for endovascular embolization.…”

Section: Implications For Treatmentmentioning

confidence: 99%

“…Obtaining and assessing these small specimens is also challenging in practice. Furthermore, because spinal dural AVFs are increasingly being treated by endovascular embolization, 14,15,17 opportunities to observe with direct microscopy and obtain surgical specimens of these lesions are fewer.…”

mentioning

confidence: 99%

Microvascular anatomy of spinal dural arteriovenous fistulas: arteriovenous connections and their relationships with the dura mater

Takai¹,

Komori

Taniguchi³

2015

SPI

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OBJECT The microvascular anatomy of spinal dural arteriovenous fistulas (AVFs), especially the relationships of the vessels with the dura mater, has yet to be angiographically demonstrated in detail and proven histologically. METHODS From January 2012 through April 2014, a total of 7 patients with spinal dural AVFs in the thoracic region underwent open microsurgical obliteration at Tokyo Metropolitan Neurological Hospital. The microvascular anatomy of spinal dural AVFs was comprehensively assessed by using advanced microangiography, including 3D computer graphics and intraoperative indocyanine green video angiography, and by histological findings. RESULTS The 2 microangiography techniques revealed the spatial course and in vivo blood flow of the meningeal vessels and their relationships with the dura mater in sufficient detail. The meningeal branch of the intercostal artery split into multiple meningeal vessels on the outer dural surface adjacent to the root sleeve. After crossing the dura mater to the inner dural surface, these vessels gathered and joined a single intradural draining vessel. On the inner dural surface, the single draining vessel was fed by the surrounding multiple meningeal vessels, which appeared to be caput medusae. Histological findings revealed that the structure of the meningeal branch of the intercostal artery corresponded to that of a normal artery. The structure of intradural draining vessels corresponded to that of a vein modified by retrograde arterial inflow. On the inner dural surface, more than 1 meningeal artery gathered and joined with the proximal radiculomedullary vein. CONCLUSIONS Spinal dural AVFs are located on the inner dural surface, where multiple direct AV connections between more than 1 meningeal feeding artery and a single proximal radiculomedullary vein occur at the site where the vein connects to the dura mater.

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“…Subsequently, angiography, in addition to its position as the gold standard of diagnosis, has experienced a continued technical and technological evolution allowing for its increasing utility in the treatment of spinal vascular malformations, either alone or in combination with surgical intervention [54]. However, there was only one EESAVM treated by endovascular embolization followed by surgical resection [33].…”

Section: Treatment and Outcomesmentioning

confidence: 99%

Exclusively Epidural Spinal Arteriovenous Malformation: A Short Review

Wang¹,

Wang²

2017

Neuropsychiatry

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The incidence of exclusively epidural spinal arteriovenous malformation (EESAVM) is extremely low and there are only a few case-reports in literature. Early, correct recognition of the pathology is mandatory to halt the progression of the disease and minimize permanent spinal cord injury. This review depicts EESAVM's characteristics, from the aspect of pathophysiology, clinical presentation, treatment strategies, and outcome. EESAVMs are located entirely in the epidural space and fed by radicular vessels or segmental arteries. The nidus of EESAVM purely locates in the spinal epidural space. The drainage of nidus flows into the epidural venous plexus or intradural vein. The retrograde blood flow from the AVM results in a diminished intramedullary blood flow and symptoms due to spinal cord ischemia and myelopathy. There is no gender predilection (male 52.9%), age distribution by the time of diagnosis shows most cases are younger than 20-year (64.7%), most cases present as spontaneous epidural hematoma (64.7%), and the majority of those lesions are located on cervicothoracic junction or upper thoracic segment (75%). Generally, the clinical presentation of EESAVM is slighter than intradural/intramedullary AVMs. Unruptured EESAVM may symptomless, or present as protracted, progressive neurological decline. Ruptured EESAVM may present acute back or thoracic pain subsequently with paraplegia. Epidural haemorrhage is common and urgent condition for EESAVM. Up to now, spinal angiography remains the gold standard and the first choice for diagnosis and characterization of spinal vascular lesion. The best management for EESAVM is still surgical operation. Prompt diagnosis and emergency surgical treatment are crucial. Long-term functional prognosis of EESAVM is good, but delayed surgical operation leave residual symptoms.

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Endovascular management of spinal vascular malformations: history and literature review

Cited by 25 publications

References 57 publications

Improved neurological function in a paediatric patient following Onyx embolization of a cervical glomus arteriovenous malformation

Improved neurological function in a paediatric patient following Onyx embolization of a cervical glomus arteriovenous malformation

Microvascular anatomy of spinal dural arteriovenous fistulas: arteriovenous connections and their relationships with the dura mater

Exclusively Epidural Spinal Arteriovenous Malformation: A Short Review

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