Intraarterial cyanoacrylate: an adjunct in the treatment of spinal/paraspinal arteriovenous malformations

Kerber, CW; Cromwell, Laurence D.; Sheptak, PE

doi:10.2214/ajr.130.1.99

Cited by 20 publications

(6 citation statements)

References 15 publications

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“…In the past they have been referred to as juvenile, metameric, or Type III AVMs (Table 5). 44,69,73,75 They respect no tissue boundary. These lesions require a multidisciplinary approach in which the team emphasizes embolization of the multiple feeding arteries, sometimes followed by staged resection.…”

Section: Extradural-intradural Arteriovenous Malformationsmentioning

confidence: 99%

Modified classification of spinal cord vascular lesions

Spetzler

Detwiler²,

Riina³

et al. 2002

Journal of Neurosurgery: Spine

358

355

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The literature on spinal vascular malformations contains a great deal of confusing terminology. Some of the nomenclature is inconsistent with the lesions described. Based on the experience of the senior author (R.F.S.) in the treatment of more than 130 spinal cord vascular lesions and based on a thorough review of the relevant literature, the authors propose a modified classification system for spinal cord vascular lesions. Lesions are divided into three primary or broad categories: neoplasms, aneurysms, and arteriovenous lesions. Neoplastic vascular lesions include hemangioblastomas and cavernous malformations, both of which occur sporadically and familially. The second category consists of spinal aneurysms, which are rare. The third category, spinal cord arteriovenous lesions, is divided into arteriovenous fistulas and arteriovenous malformations (AVMs). Arteriovenous fistulas are subdivided into those that are extradural and those that are intradural, with intradural lesions categorized as either dorsal or ventral. Arteriovenous malformations are subdivided into extradural-intradural and intradural malformations. Intradural lesions are further divided into intramedullary, intramedullary-extramedullary, and conus medullaris, a new category of AVM. This modified classification system for vascular lesions of the spinal cord, based on pathophysiology, neuroimaging features, intraoperative observations, and neuroanatomy, offers several advantages. First, it includes all surgical vascular lesions that affect the spinal cord. Second, it guides treatment by classifying lesions based on location and pathophysiology. Finally, it eliminates the confusion produced by the multitude of unrelated nomenclatural terms found in the literature.

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Section: Extradural-intradural Arteriovenous Malformationsmentioning

confidence: 99%

Modified classification of spinal cord vascular lesions

Spetzler

Detwiler²,

Riina³

et al. 2002

Journal of Neurosurgery: Spine

358

355

View full text Add to dashboard Cite

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“…[1][2][3][4]8,10,[12][13][14][20][21][22][23][24][25]29,[32][33][34][35][36][37]39,[41][42][43]45,48,50 For these 51 patients, the mean age at presentation was 15.0 ± 10.5 years (± SD), and there was a slight male sex predilection (63% male, 1.7:1 male/ female ratio) ( Table 2). Presentation modalities included progressive neurological deficits in 35% of cases, acute hemorrhage in 31%, an acute neurological deficit without hemorrhage in 22% of cases, and incidental discovery in the remaining 12%.…”

Section: Resultsmentioning

confidence: 99%

Spinal juvenile (Type III) extradural-intradural arteriovenous malformations

Gross¹,

Du²

2014

SPI

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Object Owing to their rarity, demographics, natural history, and treatment, results for spinal juvenile (Type III) extradural-intradural arteriovenous malformations (AVMs) are frequently only provided in case report format. Methods A pooled analysis was performed utilizing the PubMed database through April 2013. Individualized patient data were extracted to elucidate demographics, hemorrhage risk, and treatment result information. Results Twenty-nine studies describing 51 patients were included. The mean age at presentation was 15.0 ± 10.5 years with a slight male predilection (63%, 1.7:1 sex ratio). Presentation modality included progressive deficits in 35%, hemorrhage in 31%, acute deficits not attributed to hemorrhage in 22%, and asymptomatic/incidental in 12% of patients. The annual hemorrhage rate was 2.1%; statistically significant risk factors for hemorrhage included presentation age (HR 0.39 [95% CI 0.18–0.87]) and associated aneurysms (HR 8.74 [95% CI 1.76–43.31]). Seventy-seven percent of patients underwent treatment; after a mean follow-up of 2.6 ± 3.2 years, 73% were improved, 10% were the same, and 17% were worse neurologically. Of 25 cases with described angiographic results, 8 lesions were obliterated (32%). Of these 25 patients, 8 had AVMs with associated aneurysms, and the aneurysm was obliterated in all 8 patients. Over the course of 57.9 patient-years of follow-up, including 55.3 patient-years for partially treated AVMs, no hemorrhages were described, reflecting a trend toward protection from hemorrhage after treatment (p = 0.12, likelihood ratio test). Conclusions Spinal juvenile (Type III) extradural-intradural AVMs commonly present symptomatically. Associated arterial aneurysms increase their hemorrhage risk, and protection from hemorrhage may be achieved from partial obliteration of these lesions, particularly if targeted toward associated aneurysms.

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“…With pioneering work by Djindjian and colleagues in spinal angiography and embolization,10 our anatomic understanding of these lesions improved along with our broadened endovascular options. The introduction of cyanoacrylates as permanent embolysates by Kerber and colleagues was a particularly crucial advance 11. Kendall and Logue emphasized the key pathophysiologic insight that vein disconnection is a curative approach for these lesions,5 which catalyzed the ongoing cascade of series describing successful microsurgical disconnection 2–4…”

Section: Discussionmentioning

confidence: 99%