Management of spinal aneurysms associated with arteriovenous malformations: systematic literature review and illustrative case

Abstract

Purpose Spinal aneurysms are rare vascular malformations, commonly associated with spinal AVMs. AVM-associated spinal aneurysms are burdened by significant morbidity. The purpose of our study is to evaluate the best treatment strategy for these uncommon vascular lesions and to report an illustrative case. Methods We reviewed clinical and radiological data of a patient surgically treated at our institution for a spinal AVM with an associated prenidal aneurysm. According to PRISMA guidelines, a systematic literature review has been performed in order to discuss the best management AVM-associated prenidal aneurysms. Results In the reported case, the aneurysm showed spontaneous regression at follow-up after surgical removal of the AVM. Only 6 articles reported management of spinal prenidal AVM-associated aneurysms. Basing on our experience and data from literature, surgical treatment of the aneurysm may be indicated along with the resection of the AVM if the aneurysm is close to the nidus. Conversely, if the aneurysm is far away from the nidus or in an unfavorable position, resection of the nidus only may lead to aneurysm regression as in the reported case. Conclusions The treatment strategy for AVM-associated spinal aneurysms should be tailored on the single patient. In presence of large aneurysms that cause mass-effect symptoms, when rupture of the aneurysm is suspected or when treatment of the AVM is not proposable, direct treatment of the aneurysm should be considered. Otherwise, when complete resection of the nidus is performed, the eventually associated unruptured aneurysms located in challenging positions can be safely managed conservatively.

Spinal arteriovenous malformation with a calcified nodule: illustrative case

“… 19 Surgical interventions are indicated when the lesion is resectable. 20 In the current study, surgery was considered the most effective approach to preventing the growth of the calcified lesion and corresponding spinal cord compression.…”

Role of the Cervical Anterior Spinal Artery in the Endovascular Treatment of Vascular Diseases: Bystander, Accomplice, Victim, or Friend?

“…ASA aneurysms are rare and are mainly located in the upper cervical segment (4,(79)(80)(81)(82). They are typically dissections and can be divided into isolated and flow-related types (83,84). The flow-related type is common.…”

Dorsal intradural spinal arteriovenous fistula associated with giant intradural spinal aneurysm, a case report

“…Nidus formation, Aneurysmal lesions, and giant varices are among the most reported concurrent lesions associated with SAVM; however, these coincidences are still considered to be exceedingly rare. 2 , 3 Spinal aneurysms are rare vascular lesions arising from arterial branches supplying the spinal cord or roots. In terms of histologic features, these lesions are homologues to intracranial aneurysms with true three‐wall angio‐architecture.…”

“…SAVM is considered a developmental disease and sometimes is associated with other simultaneous vascular abnormalities. Nidus formation, Aneurysmal lesions, and giant varices are among the most reported concurrent lesions associated with SAVM; however, these coincidences are still considered to be exceedingly rare 2,3 . Spinal aneurysms are rare vascular lesions arising from arterial branches supplying the spinal cord or roots.…”