Objective – to improve the treatment quality for patients with spinal arteriovenous malformations (AVM).Materials and methods. A retrospective analysis of endovascular and surgical treatment of patients was made. In SO «Scientific-practical Center of endovascular neuroradiology NAMS of Ukraine» since 2005 till 2018 were operated 55 patients (34 (61.8 %) men and 21 (38.2 %) women). The age of patients ranged from 11 to 62 years (middle age is 45.3 years). The classification proposed by Anson and Spetzler in 1992 was used in order to divide patients into experimental groups: type I, arteriovenous fistula (AVF); type II, glomus intramedullary AVM; type III, juvenile AVM; and type IV, perimedullary AVF. Patients with type I were 36 (65.5 %), with ІІ type – 10 (18.2 %), with ІIІ type – 5 (9.0 %), with IV type – 4 (7.3 %). For diagnostics were used MRI and spinal angiography. The Aminoff–Logue scale was used for assessment of the neurological deficiency severity. Early postoperative complications (CSF) leakage, wound infection, early postoperative worsening) were counted.Results. 12 (21.8 %) patients were treated using the microsurgical method and 43 (78.2 %) were treated endovascular. We used endovascular and microsurgical methods to treat patients with I type spinal AVM. Microsurgical intervention for 9 (33 %) patients was performed. Complete disconnection of fistula was achieved in 9 patients. Early postoperative complication (CSF leakage) was observed in 1 (11 %) case. Endovascular treatment was performed for 27 (67 %) patients. Total disconnection was achieved in 16 (59 %) cases, 17 patients (63 %) had early transient neurological worsening. Embolization is the first-line treatment for patients with type II AVM – 8 (80 %) patients. Complete obliteration of AVM was attained in 5 patients (62.5 %), 6 (75 %) patients suffered from early worsening of postoperative neurological symptoms. The microsurgical method was used in case of low risk of spinal cord injury in 2 patients (20 %), AVMs were excluded totally in 2 patients and in 1 patient neurological deterioration was stabilized. All patients with III type AVM were treated endovascular. AVM was obliterated complete in 1 patient (20 %). Three (60 %) patients had transient neurological deterioration. Endovascular method was used to treat 3 (75 %) patients with type IV AVM. Totally disconnection of AVM was achieved in 1 (33 %) patient. Super-selective catheterization of all conductive arteries was not possible. Neurological worsening was observed in 1 (33 %) patient.Conclusions. Angiography is the first-line diagnostic method which permits to find the most effective and safe way (endovascular or/and microsurgical treatment) to disconnect AVM from spinal cord bloodstream. Microsurgical intervention helps to achieve eye-controlled total arteriovenous disconnection. Microsurgical technique usage leads to good neurological results – neurological improvement the following day after surgery in all cases of AVM type I treatment. The structure of AVM determines effectiveness, radicality, method of treatment and the level of feeder artery catheterization. The main goal of embolization to achieve the safe catheterization level of the afferent. Multimodal treatment, which includes endovascular and microsurgical methods, is the most effective in case of AVM II and III types.

A clinical observation of a patient presented with a typical clinic of rheumatic polymyalgia (RPM), which was a manifestation of myeloma. The relationship between rheumatic polymyalgia and giant cell arteritis (GCA) is well known, but association of RPM with lymphoproliferative diseases is rarely reported. In this case there was a clinical improvement in the patient’s condition aft er chemotherapy treatment.

В статье представлен в качестве введения мини-обзор, посвященный проблеме кожного лейкоцитокластического васкулита. Несмотря на широкую распространенность данного локального васкулита, случаи его сочетания с системными поражениями редки. Описаны единичные случаи сочетания лейкоцитокластического васкулита с поражением почек. Представлен клинический случай больного Н. с лейкоцитокластическим васкулитом в сочетании с хроническим гломерулонефритом. Оба поражения подтверждены морфологически. Предполагается, что васкулит носит системный характер и поражение почек обусловлено им. Представлены этапы ведения больного, ответ болезни на проводимую терапию. Ключевые слова: кожный лейкоцитокластический васкулит, гломерулонефрит, иммунодепрессивная терапия.

Objective – to evaluate long-term results of treatment of patients with arteriovenous malformations AVM of the spinal cord. Materials and methods. A retrospective analysis of clinical and angiographic data of the results of treatment of patients with spinal AVM for the period from 2005 to 2019 was conducted. In SO «Scientific-Practical Center of Endovascular Neuroradiology NAMS of Ukraine» 47 patients were operated on endovascular method. The age of patients ranged from 11 to 62 years (middle age is 45.3 years). There were 29 men (61.7 %), 18 women (38.3 %). Liquid cyanoacrylate embolizant was used for endovascular intervention. The operations were performed with transfemoral access. Accoding the classification proposed by Anson and Spetzler in 1992 patients with type I were 31 (65.9 %), with ІІ type – 8 (17.0 %), with ІIІ type – 5 (10.6 %), with IV type – 3 (6.4 %). Magnetic resonance tomography and spinal angiography were used for diagnostics AVM.Results. Total exclusion of AVM from the bloodstream was achieved in 22 (46.8 %) cases. Out of the 31 (65.9 %) patients with type I AVM, 17 (54.8 %) had an early transient deepening of the neurological deficit. In this group, complete dissection of arteriovenous fistula was achieved in 16 (51.6 %) patients. In 8 (17.0 %) patients with type II AVM, complete exclusion of AVM was achieved in 5 (62.5 %) cases. In this case, 6 (75.0 %) patients were observed early postoperative deepening of neurological symptoms. In 5 (10.6 %) patients with type III AVM, total exclusion was achieved in 1 (20.0 %) case. Transient deepening of neurological deficit was noted in 3 (60.0 %) patients. In 3 (75.0 %) patients with type IV AVM, total embolization was achieved in 1 (33.0 %) observation. Neurological impairment occurred in 1 (33.0 %) patient. In all groups there were no fatalities.Conclusions. Angiography is the gold standard of diagnosis and dynamic monitoring of patients with spinal cord AVM. The use of endovascular treatment of AVM can stop the further progression of neurological deficits, which, however, is not always associated with the total exclusion of AVM. The best neurological improvement and total exclusion were achieved in patients with type I AVM. Radicality, efficacy and deepening of neurological deficiency depend on angioarchitectonics of AVM. The main condition for carrying out embolization is to achieve a safe level of catheterization of the afferent.

In the period from 2013 to 2019 at the Scientific and Practical Center for Endovascular Neuroradiology of the National Academy of Medical Sciences of Ukraine, implantation of flow-diverter in the acute period of aneurysmal intracranial hemorrhage was performed in six patients (4 (66.7 %) men and 2 (33.3 %) women. The average age was 50 years). Hemorrhage was diagnosed using multispiral computed tomography, aneurysm was verified using cerebral subtraction angiography according to Seldinger. In 3 cases the aneurysm was located on the internal carotid artery, in 2 cases – on V4-segment of the vertebral artery, in1 case – on A1-segment of the anterior cerebral artery. Five patients received a loading dose of double antiplatelet therapy before implantation of a flow-diverter (300 mg clopidogrel and 300 mg acetylsalicylic acid). One patient received dual antiplatelet therapy (75 mg clopidogrel and 75 mg acetylsalicylic acid) in five days before stent implantation. All patients after implantation of a flow-diverter received double antiplatelet therapy in a standard dose (75 mg clopidogrel and 75 mg acetylsalicylic acid). In five cases a FRED (Microvention - Terumo) flow-diverter was used and in one case – Pipeline (Medtronic). The diameter and length of the stent depended on the angioantomy of the aneurysm and the bearing artery. In two cases the implantation of a flow-diverter was accompanied by the implantation of micro coils into the cavity of the aneurysm, in four cases – as a single endovascular treatment technique. There were no complications in the early or late postoperative period. At the time of discharge on the Glasgow modified exit scale (GOSE) five patients had more than 5 points, one patient died (1 point) for reasons not related to the underlying disease. A control examination in the period from 6 to 12 month after implantation passed three patients, in all cases of aneurysm from the blood circulation is totally excluded.