Intradural perimedullary arteriovenous fistulas (Type IV spinal cord arteriovenous malformations (AVM's)) are rarely reported in the literature and occasionally are classified together with Type II AVM's as intradural spinal cord AVM's. The authors report eight cases of Type IV spinal cord AVM's managed over a 2-year period. Seven of these AVM's were surgically obliterated, with intraoperative angiography being used as an adjunct; one other patient was managed using endovascular therapy. One of these lesions was definitely and another possibly the result of trauma; a malformation in a newborn infant was clearly congenital. The authors believe that the pathophysiological mechanisms and anatomical features of these lesions represent a unique spinal vascular anomaly that must be recognized angiographically to plan appropriate therapy.

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Background and Purpose-We present our single-center experience using catheter-based therapy for acute ischemic stroke patients who were not candidates for intravenous thrombolytic therapy. Methods-Neurologic outcomes were assessed in patients with acute ischemic stroke, ineligible for intravenous thrombolysis, treated with an emergent catheter-based therapy. Results-Nonparametric analysis of neurological outcomes demonstrated a benefit in National Institutes of Health Stroke Scale (NIHSS) at long-term follow-up (Pϭ0.036). Independence in daily activities and improvement in NIHSS of Ն4 points were achieved in 38% and 56% of patients, respectively. Four patients (25%) died, including 2 patients (12.5%) who died from intracranial hemorrhage. Conclusions-Catheter-based treatment offers a promising treatment strategy in patients with acute ischemic stroke ineligible for intravenous thrombolysis.

The results in the surgical management of 26 patients with arteriovenous malformations intimately related to the trigone of the lateral ventricle are presented. Three operative approaches were used in the series, including a transtemporal route through the inferior or middle temporal gyrus (15 patients), an interhemispheric approach (8 patients), and a transcortical parieto-occipital approach (3 patients). The surgical approach was chosen on the basis of the relationship of the arteriovenous malformation to the trigone, the presence and location of associated hematoma, and preoperative neurological deficits. This report emphasizes the use of surgical adjuncts that are instrumental in the management of these challenging lesions, including magnetic resonance imaging for precise localization and operative planning, preoperative embolization to obliterate deep arterial supply, and intraoperative ultrasound and angiography to aid in localization and to document complete excision of the arteriovenous malformation before closure. The results of the management of these 26 patients are as follows: 21 had no or minor neurological deficits and were able to resume premorbid activities; 2 had a fair result, being independent but unable to resume their premorbid occupation; 2 had a poor result and were dependent as the result of an incapacitating neurological deficit; and 1 died.