Semin Neurol 2002; 22(2): 123-132
DOI: 10.1055/s-2002-36535
Copyright © 2002 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Vascular Myelopathies-Vascular Malformations of the Spinal Cord: Presentation and Endovascular Surgical Management

Louis P. Caragine, Jr.1,2 , Van V. Halbach1 , Perry P. Ng1 , Christopher F. Dowd1
  • 1Division of Interventional Neuroradiology and Department of Radiology, UCSF Medical Center, San Francisco, California
  • 2Division of Neurosurgery, Geisinger Medical Center, Danville, Pennsylvania
Further Information

Publication History

Publication Date:
13 January 2003 (online)

ABSTRACT

Spinal cord vascular malformations are often a cause of spinal myelopathy. Endovascular surgical approaches to spinal cord vascular malformations have become an important adjunct and often the primary treatment of these disorders. Spinal cord vascular malformations may be divided into several categories based on their anatomy and location. They may present with a wide range of symptoms far removed from the vascular pathology. Early recognition and treatment can effect a better outcome and often reverse presenting neurologic deficits. Emerging magnetic resonance imaging techniques allow visualization of flow voids, some vascular anatomy, and intramedullary pathology and are a good screening modality. However, selective diagnostic spinal angiography remains the study of choice to diagnose and elaborate on the anatomy and potential treatment protocols. Rapidly evolving endovascular techniques and technology are revolutionizing the treatment of vascular pathology in the central nervous system, either as an adjunct to traditional neurosurgical techniques or as definitive therapy. We review the diagnosis and treatment options for spinal cord vascular malformations.

REFERENCES

  • 1 Muraszko K M, Oldfield E H. Vascular malformations of the spinal cord and dura.  Neurosurg Clin North Am . 1990;  1 631-652
  • 2 Djindjian R. Angiography of the Spinal Cord.  Baltimore: University Park Press 1970
  • 3 Anson A, Spetzler R F. Spinal dural arteriovenous malformations. In: Awad IA, Barrow DL, eds. Dural Arteriovenous Malformations Park Ridge, IL: American Association of Neurological Surgeons 1993: 175-192
  • 4 Rosenblum B, Oldfield E H, Doppman J L, Di Chiro G. Spinal arteriovenous malformations: a comparison of dural arteriovenous fistulas and intradural AVM's in 81 patients.  J Neurosurg . 1987;  67 795-802
  • 5 Biondi A, Merland J J, Hodes J E, Pruvo J P, Reizine D. Aneurysms of spinal arteries associated with intramedullary arteriovenous malformations: I. Angiographic and clinical aspects.  AJNR Am J Neuroradiol . 1992;  13 913-922
  • 6 Biondi A, Merland J J, Hodes J E, Aymard A, Reizine D. Aneurysms of spinal arteries associated with intramedullary arteriovenous malformations: II. Results of AVM endovascular treatment and hemodynamic considerations.  AJNR Am J Neuroradiol . 1992;  13 923-931
  • 7 Djindjian A. Arteriovenous malformations of the spinal cord: clinical, anatomical and therapeutic consideration-a series of 150 cases.  Prog Neurol Surg . 1978;  9 238-266
  • 8 Eldridge P R, Holland I M, Punt J A. Spinal arteriovenous malformations in children.  Br J Neurosurg . 1989;  3 393-397
  • 9 Shephard R H. Spinal arteriovenous malformations and subarachnoid haemorrhage.  Br J Neurosurg . 1992;  6 5-12
  • 10 Larson D, Halbach V. Vascular pathology and endovascular therapy. In: Lee RR, ed. Spinal Imaging Vol. 9. Philadelphia: Hanley and Belfus 1995: 245-259
  • 11 Yasargil M G, Symon L, Teddy P J. Arteriovenous malformations of the spinal cord.  Adv Tech Stand Neurosurg . 1984;  11 61-102
  • 12 Owen M P, Brown R H, Spetzler R F, Nash Jr L C, Brodkey J S, Nulsen F E. Excision of intramedullary arteriovenous malformation using intraoperative spinal cord monitoring.  Surg Neurol . 1979;  12 271-276
  • 13 Latchaw R E, Harris R D, Chou S N, Gold L H. Combined embolization and operation in the treatment of cervical arteriovenous malformations.  Neurosurgery . 1980;  6 131-137
  • 14 Horton J A, Latchaw R E, Gold L H, Pang D. Embolization of intramedullary arteriovenous malformations of the spinal cord.  AJNR Am J Neuroradiol . 1986;  7 113-118
  • 15 Riche M C, Melki J P, Merland J J. Embolization of spinal cord vascular malformations via the anterior spinal artery.  AJNR Am J Neuroradiol . 1983;  4 378-381
  • 16 Beaujeux R, Laurent A, Wassef M. Trisacryl gelatin microspheres for therapeutic embolization, II: preliminary clinical evaluation in tumors and arteriovenous malformations.  AJNR Am J Neuroradiol . 1996;  17 541-548
  • 17 Laurent A, Beaujeux R, Wassef M, Rufenacht D, Boschetti E, Merland J J. Trisacryl gelatin microspheres for therapeutic embolization, I: development and in vitro evaluation.  AJNR Am J Neuroradiol . 1996;  17 533-540
  • 18 Suh T H. Vascular system of the human spinal cord.  Arch Neurol Psychol . 1939;  41 659-677
  • 19 Sure U, Wakat J P, Gatscher S, Becker R, Bien S, Bertalanffy H. Spinal type IV arteriovenous malformations (perimedullary fistulas) in children.  Childs Nerv Syst . 2000;  16 508-515
  • 20 Kendall B, Logue V. Spinal epidural angiomatous malformations draining into intrathecal veins.  Neuroradiology . 1977;  13 181-189
  • 21 Merland J J, Riche M C, Chiras J. Intraspinal extramedullary arterio-venous fistulae draining into the medullar veins.  J Neuroradiol . 1980;  7 271-320
  • 22 Merland J J, Laurent A, Khayata M H, Casasco A, Aymard A, Gobin P. Embolization of spinal cord vascular lesions. In: Vinuela F, Dion JE, eds. Interventional Neuroradiology: Endovascular Therapy of the Central Nervous System New York: Raven Press 1992: 153-165
  • 23 Barrow D L, Colohan A R, Dawson R. Intradural perimedullary arteriovenous fistulas (type IV spinal cord arteriovenous malformations).  J Neurosurg . 1994;  81 221-229
  • 24 Mourier K L, Gelbert F, Reizine D. Phase contrast magnetic resonance of the spinal cord preliminary results in spinal cord arterio-venous malformations.  Acta Neurochir (Wien) . 1993;  123 57-63
  • 25 Thorpe J W, Kendall B E, MacManus D G, McDonald W I, Miller D H. Dynamic gadolinium-enhanced MRI in the detection of spinal arteriovenous malformations.  Neuroradiology . 1994;  36 522-529
  • 26 Tani S, Ikeuchi S, Hata Y, Abe T. Vascular orientation by intra-arterial dye injection during spinal arteriovenous malformation surgery.  Neurosurgery . 2001;  48 240-242
  • 27 Halbach V V, Higashida R T, Dowd C F, Fraser K W, Edwards M S, Barnwell S L. Treatment of giant intradural (perimedullary) arteriovenous fistulas.  Neurosurgery . 1993;  33 972-980
  • 28 Koenig E, Thron A, Schrader V, Dichgans J. Spinal arteriovenous malformations and fistulae: clinical, neuroradiological and neurophysiological findings.  J Neurol . 1989;  236 260-266
  • 29 Kataoka H, Miyamoto S, Nagata I, Ueba T, Hashimoto N. Venous congestion is a major cause of neurological deterioration in spinal arteriovenous malformations.  Neurosurgery . 2001;  48 1224-1230
  • 30 Larsen D W, Halbach V V, Teitelbaum G P. Spinal dural arteriovenous fistulas supplied by branches of the internal iliac arteries.  Surg Neurol . 1995;  43 35-41
  • 31 Song J K, Gobin Y P, Duckwiler G R. N-Butyl 2-cyanoacrylate embolization of spinal dural arteriovenous fistulae.  AJNR Am J Neuroradiol . 2001;  22 40-47
  • 32 Nichols D A, Rufenacht D A, Jack Jr R C, Forbes G S. Embolization of spinal dural arteriovenous fistula with polyvinyl alcohol particles: experience in 14 patients.  AJNR Am J Neuroradiol . 1992;  13 933-940
  • 33 Foo D, Chang Y C, Rossier A B. Spontaneous cervical epidural hemorrhage, anterior cord syndrome, and familial vascular malformation.  Neurology . 1980;  30 1253-1254
  • 34 Halbach V V, Higashida R T, Hieshima G B. Treatment of vertebral arteriovenous fistulas.  AJR Am J Roentgenol . 1988;  150 405-412
  • 35 Janda J, Mracek Z. [Angioreticuloma of the brain stem: simultaneous occurrence of an arteriovenous malformation in the epidural space of the cervical spinal cord].  Cesk Neurol Neurochir . 1978;  41 397-399
  • 36 Willinsky R, terBrugge K, Montanera W, Wallace M C, Gentili F. Spinal epidural arteriovenous fistulas: arterial and venous approaches to embolization.  AJNR Am J Neuroradiol . 1993;  14 812-817
  • 37 Schmorl G. Tumors and tumor metastases. In: Schmorl G, Besemann EF, Junghanns H, eds. The Human Spine in Health and Disease New York: Grune & Stratton 1971: 325-327
  • 38 Fox M W, Onofrio B M. The natural history and management of symptomatic and asymptomatic vertebral hemangiomas.  J Neurosurg . 1993;  78 36-45
  • 39 Ross J S, Masaryk T J, Modic M T, Carter J R, Mapstone T, Dengel F H. Vertebral hemangiomas: MR imaging.  Radiology . 1987;  165 165-169
  • 40 Lee S, Hadlow A T. Extraosseous extension of vertebral hemangioma, a rare cause of spinal cord compression.  Spine . 1999;  24 2111-2114
  • 41 Nassar S I, Hanbali F S, Haddad M C, Fahl M H. Thoracic vertebral hemangioma with extradural extension and spinal cord compression: case report.  Clin Imaging . 1998;  22 65-68
  • 42 Miszczyk L, Ficek K, Trela K, Spindel J. The efficacy of radiotherapy for vertebral hemangiomas.  Neoplasma . 2001;  48 82-84
  • 43 Heyd R, Strassmann G, Filipowicz I, Borowsky K, Martin T, Zamboglou N. [Radiotherapy in vertebral hemangioma].  Rontgenpraxis . 2001;  53 208-220
  • 44 Brackrock S, Krull A, Schwarz R, Alberti W. [Results of radiotherapy for vertebral hemangioma].  Strahlenther Onkol . 1999;  175 405-408
  • 45 Winkler C, Dornfeld S, Baumann M, Christen N, Herrmann T, Eberhardt H J. [The efficacy of radiotherapy in vertebral hemangiomas].  Strahlenther Onkol . 1996;  172 681-684
  • 46 Bremnes R M, Hauge H N, Sagsveen R. Radiotherapy in the treatment of symptomatic vertebral hemangiomas: technical case report.  Neurosurgery . 1996;  39 1054-1058
  • 47 Goyal M, Mishra N K, Sharma A, Gaikwad S B, Mohanty B K, Sharma S. Alcohol ablation of symptomatic vertebral hemangiomas.  AJNR Am J Neuroradiol . 1999;  20 1091-1096
  • 48 Doppman J L, Oldfield E H, Heiss J D. Symptomatic vertebral hemangiomas: treatment by means of direct intralesional injection of ethanol.  Radiology . 2000;  214 341-348
  • 49 Bas T, Aparisi F, Bas J L. Efficacy and safety of ethanol injections in 18 cases of vertebral hemangioma: a mean follow-up of 2 years.  Spine . 2001;  26 1577-1582
  • 50 Nguyen J P, Djindjian M, Pavlovitch J M, Badiane S. [Vertebral hemangioma with neurologic signs: therapeutic results. Survey of the French Society of Neurosurgery].  Neurochirurgie . 1989;  35 299-308