Spinal Vascular Malformation Treatment [Neurosurgery Wiki]

This page is read only. You can view the source, but not change it. Ask your administrator if you think this is wrong.
====== Spinal Vascular Malformation Treatment ======

Type I (dural AVMs) from the [[American English French Connection Classification]]: usually require treatment. Usually amenable to [[endovascular technique]]s using [[glue]], in which case the proximal vein must be taken as well. If you don’t completely eliminate a [[dural fistula]] (spinal or intracranial) it will come back!

see [[Spinal dural arteriovenous fistula treatment]].
----
Type II (spinal glomus AVMs): may be amenable to interventional neuroradiologic procedures including embolization,
((Anson JA, Spetzler RF. Interventional Neuroradiology for Spinal Pathology. Clin Neurosurg. 1991; 39: 388–417)) 
especially type IIA (single feeder). However recurrence may be higher with endovascular treatment than surgery, and surgery is often preferred for Type IIB (≥2 feeders). Surgical strategy: similar to intracranial AVMs, except that the parenchyma cannot be retracted, bleeding is rarely life-threatening, and arteries of passage must be preserved to avoid devastating deficits. Intraoperative ICG angio is often helpful. The nidus is compact, and the hemosiderin ring around the nidus on MRI often represents a plane that can be exploited.
----
Type III (juvenile spinal AVMs): the natural history is probably better than the prognosis with any type of treatment.
----
Type IV (perimedullary fistulae): suggested management:

Suggested management for Type IV arteriovenous fistulae
((Mourier KL, Gobin YP, George B, et al. Intradural Perimedullary Arteriovenous Fistulae: Results of Surgical and Endovascular Treatment in a Series of 35 Cases. Neurosurgery. 1993; 32:885–891))
  
Subtype I difficult;? reliability of MRI
(due to inaccuracy, do not delay angiogram to get MRA, etc.);
difficult easy on [[filum terminale]]; difficult on tomomyelography; [[conus medullaris]] angiotomomyelography.
----
Subtype II, diagnosis: easy: MRI or myelography, embolization: incomplete occlusion, surgery on posterolateral AVFs
----
Subtype III diagnosis easy: MRI or myelography, embolization: effective, surgery difficult dangerous.
----
Diagnosis and treatment of [[spinal dural arteriovenous fistula]] (type I) as well as [[spinal arteriovenous malformation]]s (type II-V) ideally require a close co-operation between neurosurgeons and neuroradiologists. Surgery can, in general, be considered as curative. [[Endovascular therapy]] of [[arteriovenous malformation]]s results in the reduction of size and concomitant hemodynamic effects. A curative approach is generally not possible. Particularly in cases of lumbosacral and craniosacral [[arteriovenous fistula]]s the interventional procedure provides advantages. Treatment of spinal [[cavernoma]]s nowadays consists of neurosurgical approaches exclusively. The significance of radiosurgical therapy, especially with the [[CyberKnife]], remains indistinct. Today, interdisciplinary neurosurgical and neuroradiological co-operation in specialized centers allows most spinal vascular malformations to be diagnosed at an early stage and to be treated with satisfying results
((Eicker S, Turowski B, Steiger HJ, Hänggi D. [Diagnostic work-up and therapy of
spinal vascular malformations: an update]. Nervenarzt. 2010 Jun;81(6):719-26.
doi: 10.1007/s00115-010-2971-2. Review. German. PubMed PMID: 20386874.
)).

===== Spinal arteriovenous malformation surgery =====
[[Spinal arteriovenous malformation surgery]]

===== References =====