Modern management of spinal and spinal cord vascular lesions

Abstract

Spinal arteriovenous shunts affect all age groups from neonates to the elderly in connection with different entities. The authors present 7 illustrative cases of spinal and spinal cord vascular lesions with different etiology, angioarchitecture, symptoms, risks, and prognosis, but similar pathophysiology: spinal cord AVM, multifocal AVM with venous impairment, paraspinal arteriovenous fistulas in children, spinal dural AV fistula, and an arteriovenous malformation of the filum terminale. Therapy was consistent and demonstrated the benefit of combined treatment. Specific endovascular embolisation with a permanent liquid substance (NBCA) is the method of choice. In 5 of the 7 patients, the malformation was completely occluded in one therapeutic session. Two patients needed additional embolisation. Systemic or neurological symptoms improved or regressed completely in all cases. No patient has had more than 3 sessions of endovascular approach. The filum terminale AVM was treated by direct surgery due to the risks of endovascular approach. As shown by our observations, venous flow in the intrinsic network of the spinal cord is highly sensitive to hemodynamic changes. Thus, the hemodynamic balance must be maintained to obtain stable embolisation results, particularly if a considerable size reduction of the AV shunt has been achieved.