Vascular Myelopathies - Vascular Malformations of the Spinal Cord: Presentation and Endovascular Surgical Management

Louis P. Caragine, Jr., MD, PhD, Van V. Halbach, MD, Perry P. Ng, MD, Christopher F. Dowd, MD

Disclosures

Semin Neurol. 2002;22(2) 

In This Article

Abstract and Introduction

Abstract

Spinal cord vascular malformations are often a cause of spinal myelopathy. Endovascular surgical approaches to spinal cord vascular malformations have become an important adjunct and often the primary treatment of these disorders. Spinal cord vascular malformations may be divided into several categories based on their anatomy and location. They may present with a wide range of symptoms far removed from the vascular pathology. Early recognition and treatment can effect a better outcome and often reverse presenting neurologic deficits. Emerging magnetic resonance imaging techniques allow visualization of flow voids, some vascular anatomy, and intramedullary pathology and are a good screening modality. However, selective diagnostic spinal angiography remains the study of choice to diagnose and elaborate on the anatomy and potential treatment protocols. Rapidly evolving endovascular techniques and technology are revolutionizing the treatment of vascular pathology in the central nervous system, either as an adjunct to traditional neurosurgical techniques or as definitive therapy. We review the diagnosis and treatment options for spinal cord vascular malformations.

Objectives: On completion of this article the reader will be able to recognize the clinical presentation of myelopathy due to vascular disturbance, list the common forms of vascular pathology in the spinal cord, and summarize current views on treatment options.
Accreditation: The Indiana University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
Credit: The Indiana University School of Medicine designates this educational activity for a maximum of 1.0 hours in category one credit toward the AMA Physicians Recognition Award. Each physician should claim only those hours of credit that he/she actually spent in the educational activity.
Disclosure: Statements have been obtained regarding the authors' relationships with financial supporters of this activity. There is no apparent conflict of interest related to the context of participation of the authors of this article.

Introduction

Vascular malformations of the spinal cord are a major cause of spinal cord myelopathy. These are complex disorders with complex management. Endovascular surgical approaches to spinal cord vascular malformations have become an important adjunct and often the primary treatment of these disorders.

Patients present with a wide range of signs and symptoms, often distal to the site of the pathology, and early recognition, diagnosis, and treatment offer the best chance of neurologic recovery.[1] Selective spinal angiography remains the "gold standard" for visualization of the intricate vascular anatomy; embolization, pioneered by Rene Djindjian and colleagues,[2] provides the endovascular means of therapy. We will classify, discuss, and delineate the endovascular therapy of spinal cord vascular malformations.

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