Clinical Features and Outcomes of Spinal Cord Arteriovenous Malformations

Abstract

Background and Purpose-As a result of the rarity of spinal cord arteriovenous malformations (AVM), there are only a few series available that describe clinical features, outcome after treatment, and natural history of these lesions. In this article, we aim to describe our experience with both nidus-and fistulous-type spinal cord AVMs. Methods-Forty-four consecutive patients with spinal cord AVMs were retrospectively reviewed. There were 26 patients with a nidus-type and 18 patients with a fistulous-type AVM. Treatments were performed with embolization (n=23), surgery (n=13), combined embolization-surgery (n=3), or conservative management (n=5). Clinical features, radiological findings, treatment results, and clinical outcomes were assessed. Results-Patients with nidus-type AVMs were younger at presentation and more often presented with hemorrhage, with a higher proportion of hematomyelia than fistulous-type AVMs (P<0.05). Progression of clinical presentation from hemorrhage to congestive myelopathy during follow-up was noted in 5 patients, all of which had AVMs of the nidus type. Complete obliteration could be achieved more often in the fistulous type (72%) than in the nidus type (27%). Improved or stable clinical status at last follow-up was noted in 100% of fistulous-type and 77% of nidus-type patients. Long-term clinical deterioration was noted in 6 of 26 patients with nidus-type (23%) AVMs and was related to recurrent bleeding (n=3) or progressive venous congestion (n=3). Overall rebleed rate after presentation with hemorrhage was 7 in 145.5 patient-years (4.8%/y) if the lesion was not treated, 3 in 102 patient-years (2.9%/y) after partial treatment, and 0 in 47.5 patient-years (0%) after complete treatment. Conclusions-Nidus

Clinical biomarkers differentiate myelitis from vascular and other causes of myelopathy

“…These findings are in agreement with previous descriptions of spinal cord stroke, 18 , 19 compressive myelopathies, 4 , 5 and vascular malformations. 7 , 20 …”

“… 3 – 5 While CSF pleocytosis or lesion enhancement on MRI have been widely used to define inflammatory myelopathies, similar features have been reported in non-inflammatory myelopathies. 3 , 4 , 6 , 7 The overlap of clinical, MRI, and CSF features among the wide spectrum of myelopathies may lead to an erroneous diagnosis of TM, and subsequent unwarranted treatments with potentially harmful immunosuppressive therapies and delays in adequate therapeutic measures. 8 , 9 …”

Endovascular management of aneurysms associated with spinal arteriovenous malformations

“…Patients with nidus-type AVMs are younger at presentation and more often present with hemorrhage, with a higher proportion of hematomyelia than fistulous-type AVMs 2. Non-hemorrhagic acute neurological deficits may be present because of acute thrombosis of venous pouches with mass effect and disturbance of venous outflow.…”

Ruptured Spinal Arteriovenous Malformation: A Rare Cause of Paraplegia in Pregnancy

“…Spinal vascular malformations, including arteriovenous malformations (AVMs), are rare. Prompt diagnosis and treatment may prevent long-term neurological disability [ 1 – 3 ]. Patients with spinal AVMs usually present with back pain and progressive myelopathy with gait disturbance, sensory changes, and bladder or bowel symptoms [ 1 – 3 ].…”

“…Prompt diagnosis and treatment may prevent long-term neurological disability [ 1 – 3 ]. Patients with spinal AVMs usually present with back pain and progressive myelopathy with gait disturbance, sensory changes, and bladder or bowel symptoms [ 1 – 3 ]. Proposed mechanisms for neurological deterioration include haemorrhage, redistribution of blood supply (“steal phenomena”), mass effect, or venous congestion [ 1 , 4 ].…”