Spinal Vascular Malformation [Neurosurgery Wiki]

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====== Spinal Vascular Malformation ======

===== General information =====

Often also referred to by the term [[spinal AVM]]s, which technically refers to a subset of spinal [[vascular malformation]]s (SVMs). The incidence of [[SVM]] is about 4% of primary [[intraspinal]] [[mass]]es. 80% occur between [[age]] 20 and 60 years
((Youmans JR. Neurological Surgery. Philadelphia 1982)).

The [[literature]] on [[spinal vascular malformation]]s contains a great deal of confusing [[terminology]]. Some of the [[nomenclature]]s is inconsistent with the [[lesion]]s described.

===== History =====

==== Epochs ====

Black 
((Black P. Spinal vascular malformations: an historical perspective. Neurosurg
Focus. 2006 Dec 15;21(6):E11. PubMed PMID: 17341044.
))
identifies three epochs in the development of the concepts and treatment of [[spinal vascular lesion]]s:

1) early [[observation]]s (1860s-1912), with the [[lesion]]s during this time period recognized only at [[autopsy]]

2) the "middle ages" (1912-1960), with [[surgical intervention]] sporadic and yielding dismal results

3) the modern era (beginning in the [[1960]]s), coincident with parallel dramatic advances in [[radiology]], microsurgical [[instrumentation]], and [[anesthesiology]]. These advances resulted in a better understanding of the pathophysiological aspects and angioarchitecture of the lesions. Whereas the [[nomenclature]] of the lesions in the past was confusing, a new understanding of these diseases that have emerged during the modern era has permitted refinement of the [[classification]] of the lesions as distinct biological entities. Modern diagnostic imaging has enabled the identification of patients who may benefit from surgical or embolic [[occlusion]], and [[treatment]] has become rationally based. Future progress in the [[management]] of [[spinal vascular lesion]]s may be anticipated, with improvement in noninvasive imaging for early detection of suspected abnormalities. Furthermore, advances in spinal cord [[neuroprotection]] may expand the range of future options for surgical or embolic intervention
((Black P. Spinal vascular malformations: an historical perspective. Neurosurg
Focus. 2006 Dec 15;21(6):E11. PubMed PMID: 17341044.
)).
----
From the earliest observations of spinal [[vascular malformation]]s, successful management has been challenging. Initially the challenges were diagnosing, understanding, and treating these lesions. They were originally considered all to be the same, or at least to be a single general type, of disease. With the introduction of selective [[spinal arteriography]] in the 1960s and more recently with the introduction and widespread use of MR imaging, the initial challenge of diagnosing spinal vascular malformations was overcome, and significant progress has been made in understanding their anatomy as well as the pathophysiology that underlies the myelopathy commonly associated with them. The anatomical features defined by selective arteriography and the observations permitted with the operating microscope ultimately led to distinctions between the major categories of the vascular lesions affecting the spinal cord; these distinctions were based on the lesions' anatomy, epidemiology, and the mechanism of spinal cord injury
((Oldfield EH. Introduction: Spinal vascular malformations. Neurosurg Focus.
2009 Jan;26(1):E1. doi: 10.3171/FOC.2009.26.1.E1. PubMed PMID: 19119887.
)).
===== Epidemiology =====

The incidence of [[SVM]] is about 4% of primary [[intraspinal]] [[mass]]es. 80% occur between [[age]] 20 and 60 years
((Youmans JR. Neurological Surgery. Philadelphia 1982)).



===== Classification =====

[[Spinal vascular malformation classification]].


===== Clinical features =====

[[Spinal Vascular Malformation clinical features]].

===== Diagnosis =====

[[Spinal Vascular Malformation Diagnosis]].


===== Treatment =====

[[Spinal Vascular Malformation Treatment]].

===== Case series =====

[[Spinal Vascular Malformation case series]].

===== References =====