Angio-architecture of spinal cord arteriovenous shunts at presentation. Clinical correlations in adults and children

Abstract

The short term prognosis of hemorrhagic SCAVSs is good, and there is no need for emergency treatment. MRI delineates the cord and makes the diagnosis of the lesion but angiography remains the gold standard for analysis of the vasculature. The angio-architecture reflects the ageing of the lesion but there is not a precise correlation between angio-architecture and clinical symptoms, except for pseudoaneurysms which relate to the hemorrhagic portion of the lesion.

Cervical Perimedullary Arteriovenous Fistula in an Infant Presenting With Subarachnoid Hemorrhage -Case Report-

“…Type III perimedullary AVFs have been reported in several children with SAH, 8,[18][19][20][21] but none in infants with SAH. The reported annual incidence of SAH in individuals younger than 15 years is 1 case per 1 000 000 population.…”

“…In one series, 21 of 30 children with spinal AVM presented with hemorrhage, of whom 10 had SAH, and 11 exhibited hematomyelia. 19) Approximately 50% of children with intradural AVM presented with SAH. 22) These findings indicate that spinal AVM is an important element of the differential diagnosis in children with SAH, especially those without intracranial abnormalities.…”

“…Perimedullary AVFs were treated initially with clipping, 5) but recently with embolization 1,2,5,7,8,[19][20][21] and combined embolization and surgery. 1,7,8,14,15,[18][19][20][21]23) The presence of small pial artery networks around the spinal cord 11) hinder complete isolation of the AVF by clipping of the large feeding arteries.…”

“…1,7,8,14,15,[18][19][20][21]23) The presence of small pial artery networks around the spinal cord 11) hinder complete isolation of the AVF by clipping of the large feeding arteries.…”

“…19) Indeed, emergent embolization may carry a higher risk of complications. 4) The favorable outcome in our patient demonstrated the importance of spinal cord imaging in infants with SAH but without other intracranial abnormalities to detect the presence of perimedullary AVF.…”