Surgical Treatment of Spinal Extramedullary AVM

享, 宮本; 晴彦, 菊池; 泉, 永田; 好人, 鳴尾; 淳, 唐澤; 尚, 宍戸

doi:10.2531/spinalsurg.1.67

Cited by 1 publication

(1 citation statement)

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“…We added the following new types of malformations to the proposed classification: the intramedullary diffuse AVM described earlier; 15 the intradural perimedullary AVM described by Miyamoto, et al, 11 and also found in our observations; and the dural AVM, epidural AVM and AVF, and an intervertebral AVM discovered in our clinical material. Epidural AVFs were described earlier by Asai, et al 1 We observed intramedullary AVMs of the conus medullaris, as did Spetzler, et al, 19 but in our obser-vations there were also perimedullary AVFs, which were situated in the conus region and received inflow from the arteries passing among the cauda equina.…”

Section: Discussionmentioning

confidence: 88%

Spinal arteriovenous malformations: new classification and surgical treatment

Zozulya¹,

Slinko²,

Al-Qashqish³

2006

FOC

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Object Spinal vascular malformations represent rare and insufficiently studied pathological entities characterized by considerable variation. Insufficient study of this disease is connected with the complexity of its diagnosis, which restricts the development of surgical treatments that are differentiated according to the type of malformation. Great difficulties are caused by the lack of a clear structural–hemodynamic classification of spinal arteriovenous malformations (AVMs). At present the classification created between 1991 and 1998 by the combined efforts of different authors is the most widely used one. According to this classification, four categories are distinguishable: Type I, dural arteriovenous fistulas (AVFs); Type II, intramedullary glomus AVMs; Type III, juvenile or combined AVMs; and Type IV, intradural perimedullary AVFs. Vascular tumors are also classified, as follows: hemangiomas, hemangioblastomas, angiosarcomas, hemangiopericytomas, angiofibromas, angiolipomas, and hemangioendotheliomas, as well as cavernous malformations. Methods In this study the authors analyze the diagnostic data and results of treatment in 91 patients with AVMs and AVFs who were treated at the Institute of Neurosurgery between 1995 and 2005. The patients' ages ranged from 9 to 83 years; the mean age was 42.9 years. For spinal vascular malformations we devised a classification that took into account the aforementioned features of AVMs: the anatomical characteristics of a malformation and its angiostructural and hemodynamic features. In all patients the neuroimaging modalities used in the investigation of their lesions included magnetic resonance (MR) imaging and selective spinal angiography. Three-dimensional computerized tomography angiography studies were obtained in 14 patients, and MR angiography was used in 17. Conclusions For successful surgical treatment of spinal AVMs it is necessary to obtain data about their localization, vascular structure, and hemodynamics that are as complete as possible. This information will promote the use of optimum surgical procedures and the latest methods of microsurgical and endovascular interventions, with treatments differentiated according to the type of malformation. One should try to use the least invasive endovascular approach in these cases,where possible, to occlude the AVM or reduce the intensity of blood flow by means of embolization. To perform an AVM resection or occlusion, one should use a direct approach to the malformation, blocking only the vessels supplying blood to the malformation and preserving the vessels feeding the spinal cord.

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Section: Discussionmentioning

confidence: 88%