Management of juvenile spinal AVM's by embolization and operative excision

Spetzler, Robert F.; Zabramski, Joseph M.; Flom, Richard A.

doi:10.3171/jns.1989.70.4.0628

Cited by 86 publications

(32 citation statements)

References 15 publications

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“…Patients with multiple lesions not fitting a strict metameric distribution may represent a subset with incomplete phenotypic expression of the somatic defect(s), analogous to those with isolated, solitary lesions. In these diffuse angiomas, a complete obliteration or resection is almost never possible [52]. In SAMS cases, we again adopt the strategy of a partially targeted embolization to reduce shunting zones and to obliterate potential focal weak points.…”

Section: Spinal Cord Arteriovenous Malformationsmentioning

confidence: 99%

Vascular Malformations of the Spine and Spinal Cord*

Krings

2010

Clin Neuroradiol

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Spinal vascular malformations are rare diseases with a wide variety of neurologic presentations. Their classification depends on the differentiation of shunting versus nonshunting lesions, the latter being the spinal cord cavernomas. In the shunting lesions, the next step in the proposed classification scheme is related to the feeding artery which can subdivide the dural vascular shunts from the pial vascular malformations: while those shunts that are fed by radiculomeningeal arteries (i.e., the counterparts of meningeal arteries in the brain) constitute the dural arteriovenous fistulas, the shunts that are fed by arteries that would normally supply the spinal cord (i.e., the radiculomedullary and radiculopial arteries) are the pial cord arteriovenous malformations (AVMs; whose cranial counterparts are the brain AVMs). Depending on the type of transition between artery and vein, the latter pial AVMs can be further subdivided into glomerular (plexiform or nidus-type) AVMs with a network of intervening vessels in between the artery and vein and the fistulous pial AVMs. The last step in the classification then describes whether the type of fistula has a high or a low shunting volume which will differentiate the "macro-" from the "micro"fistulas. The proposed classification is therefore based on a stepwise analysis of the shunt including its arterial anatomy, its nidus architecture and its flow-volume evaluation. The major advantage of this approach is that it leads to a subclassification with direct implications on the choice of treatment, thereby constituting a simple and practical approach to evaluate these rare diseases.

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Section: Spinal Cord Arteriovenous Malformationsmentioning

confidence: 99%

Vascular Malformations of the Spine and Spinal Cord*

Krings

2010

Clin Neuroradiol

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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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“…Although reports of improvement and occasional case reports of cure do exist, 52 treatment is largely considered palliative in nature. 59 …”

Section: Juvenile Avmsmentioning

confidence: 99%

Endovascular management of spinal vascular malformations: history and literature review

Medel

Crowley

Dumont

2009

FOC

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Spinal vascular malformations represent a complex group of entities whose treatment paradigm continually evolves. Given the ever-increasing role of endovascular therapy, it is the goal of the authors to review the current literature regarding this therapeutic tool and to provide recommendations guiding management. A thorough literature search was conducted using Medline, with subsequent articles being identified through cross-referencing. The analysis revealed that, since its introduction in the 1960s, endovascular therapy has been used to manage the entire spectrum of spinal vascular malformations, during which period it has undergone considerable technological and technical evolution. As such, embolization has proved of growing therapeutic utility, largely resulting from the mounting evidence supporting its safety and efficacy, in addition to the inherent minimally invasive nature. This alternative to surgical intervention will be increasingly used as first-line therapy in spinal vascular malformations.

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Management of juvenile spinal AVM's by embolization and operative excision

Cited by 86 publications

References 15 publications

Vascular Malformations of the Spine and Spinal Cord*

Vascular Malformations of the Spine and Spinal Cord*

Spinal juvenile (Type III) extradural-intradural arteriovenous malformations

Endovascular management of spinal vascular malformations: history and literature review

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