Vascular anatomy of the spinal cord and classification of spinal arteriovenous malformations

Abstract

The arterial and venous anatomy of the spinal cord was described in terms of extrinsic and intrinsic contribution to the cord substance. Based upon anatomical location of an arteriovenous shunt, spinal arteriovenous malformations (AVMs) were classified into intramedullary AVM, perimedullary arteriovenous fistula (AVF) and dural AVF. This simple classification seems practical from the standpoint of endovascular and surgical treatments since it reflects anatomical differences in the shunt location, which is the target in either approach.

Figure 1

Schematic drawing of the arterial supply to the spinal cord. ASA, anterior spinal artery; PA, pial artery; PAN, pial arterial network; PSA, posterior spinal artery; RA, radicular artery; RPA, radiculopial artery; RMA, radiculomedullary artery; SA, sulcul artery.

Figure 2

Schematic drawing of the venous drainage of the spinal cord. ASV, anterior spinal vein; SV, sulcul vein; PSV, posterior spinal vein; PV, pial vein; PVN, pial venous network; RPV, radial perforating vein; TA, transmedullary anastomosis; RV, radicular vein; RMV, radiculomedullary vein.

Figure 3

Types of spinal AVMs. Intradual AVM (upper row) consists of the intramedullary AVM (left) and perimedullary AVF (right). Dural AVF (lower row) presents with intradural drainage (left) or extradural drainage (right). The site of A-V shunt is indicated by an arrow head.