A Review of Vascular Abnormalities of the Spine

Abstract

Patients with spinal vascular lesions present with unique symptoms and have important anatomical and physiologic changes that must be considered prior to treatment. In this mini-review, we provide an overview of normal spinal vascular anatomy and discuss several key spinal vascular lesions. We provide an overview of cavernous malformations, intradural arteriovenous malformations, perimedullary arteriovenous fistulas, and dural arteriovenous fistulas. Important considerations are addressed in terms of pathologic characterization, specific imaging findings, and treatment approaches.

Keywords: Spine; Vascular lesions.

Figure 1

DSA Artery of Adamkiewz with characteristic hairpin turn prior to feeding into the anterior spinal artery.

Figure 2

Cavernous malformations are composed of back-to-back, thin-walled vessels with minimal intervening tissue and are surrounded by gliosis with associated hemosiderin pigment deposition.

Figure 3

Axial T1WI showing heterogenous areas of low signal from presence of prior hemorrhage characteristic of cavernous malformations.

Figure 4

Arteriovenous malformations are characterized by abnormal vessels of varying caliber with intervening gliotic neural tissue.

Figure 5

Sagittal T2WI showing intramedullary mass with mulberrylike areas of hypointesnsity consistent with hemosiderin staining consistent with prior hemorrhage.

Figure 6

Sagittal CTA Perimedullary AVF showing prominent early filling of perimedullary vein.

Figure 7

Spinal DSA showing perimedullary AVF supplied by multiple arterial feeders.

Figure 8

Dural arteriovenous fistulas are complicated by necrotic/vacuolated spinal cord tissue with associated vascular congestion.