Embolization with particles in thoracic intramedullary arteriovenous malformations: long-term angiographic and clinical results.

Biondi, Alessandra; Merland, J. J.; Reizine, D.; Aymard, A; Hodes, Jonathan E.; Lecoz, Patrick; A, Rey

doi:10.1148/radiology.177.3.2243964

Cited by 123 publications

(42 citation statements)

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“…Acute neurological deterioration due to bleeding, such as subarachnoid hemorrhage and intramedullary hemorrhage, is known as the most common clinical presentation of spinal AVMs. 7,9,29 However, only 2 cases (17%) in this study presented with hemorrhage. Slow and gradual progression may be explained by direct cord compression or venous hypertension.…”

Section: Spinal Avmscontrasting

confidence: 52%

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Clinical features and treatment outcomes of the spinal arteriovenous fistulas and malformations

Cho

Kim

Kwon

et al. 2013

SPI

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Object Spinal vascular diseases, such as spinal dural arteriovenous fistulas (DAVFs), perimedullary arteriovenous fistulas (AVFs), and spinal arteriovenous malformations (AVMs), are very rare. The authors analyzed the features and treatment outcomes of these conditions. Methods Data from 64 patients were retrospectively reviewed. There were 33 spinal DAVFs (1 patient had 2 lesions), 20 perimedullary AVFs, and 12 spinal AVMs. Clinical features, radiological findings, treatment results, and clinical outcomes were evaluated according to the diseases, subtypes, and treatment modalities. The median duration of follow-up was 20, 42, and 56 months for spinal DAVFs, perimedullary AVFs, and spinal AVMs, respectively. Results Spinal DAVFs showed faster progression of symptoms (median 5, 12, and 36 months for spinal DAVFs, perimedullary AVFs, and spinal AVMs, respectively) and worse neurological status at diagnosis (poor neurological status in 56%, 65%, and 33%, respectively). On MRI, signal voids were demonstrated in all except 1 spinal DAVF. At the last follow-up, 94% of spinal DAVFs, 68% of perimedullary AVFs, and 50% of spinal AVMs were completely obliterated. Favorable clinical outcomes were achieved in 91%, 95%, and 58%, respectively. In detail, the majority (78%) of spinal DAVFs were embolized, resulting in complete obliteration in 92% and favorable clinical outcomes in 92%. Most Type IVa and IVb perimedullary AVFs were surgically treated (71% and 88%), with complete obliterations of 86% and 71%, and favorable clinical outcomes in 100% and 86%, respectively. All Type IVc lesions were embolized with a low cure rate of 40%; however, clinical outcomes were satisfactory. Spinal AVMs were generally embolized (67%), and only glomus-type lesions attained a satisfactory cure rate (80%) and clinical outcome (100%). Conclusions Embolization produced satisfactory outcomes in spinal DAVFs and glomus-type spinal AVMs. Surgery is advantageous in Type IVa and IVb perimedullary AVFs. Palliative embolization can be effective in Type IVc perimedullary AVFs and juvenile spinal AVMs.

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Section: Spinal Avmscontrasting

confidence: 52%

“…5,10,29 Symptoms tend to occur acutely from the rupture of a nidus, whereas gradual deterioration is less common. 7,9,29 Because the angioarchitecture is complex, partial obliteration to reduce shunt flow and removal of hazardous components, such as associated aneurysms and varices, are usually the goals of treatment and not complete exclusion.…”

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confidence: 99%

Clinical features and treatment outcomes of the spinal arteriovenous fistulas and malformations

Cho

Kim

Kwon

et al. 2013

SPI

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“…The low incidence of hemorrhage after partial embolization of SCAVMs has also been reported by other authors. 5 Associated aneurysms of the feeding arteries and nidus are common in SCAVMs. 7 Spinal cord artery and intranidal aneurysms are associated with a high risk for hemorrhage in SCAVMs.…”

Section: Hemorrhagementioning

confidence: 99%

“…Treatment of an SCAVM aims to decrease the risk of hemorrhage and arrest the progression of neurologic deterioration. 5 Embolization is thought to play an important role in the management of SCAVMs, both as a primary treatment and as an adjunct to surgical excision. However, complete cure of SCAVMs by endovascular embolization is exceptional except for spinal cord AVFs, and endovascular treatment often results in partial obliteration of the lesion by target embolization.…”

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confidence: 99%

The Preventive Effect of Endovascular Treatment for Recurrent Hemorrhage in Patients with Spinal Cord Arteriovenous Malformations

Niimi¹,

Matsukawa

Uchiyama

et al. 2015

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE:Spinal cord AVMs represent rare and insufficiently studied pathologic entities. Embolization is thought to play an important role in the management of spinal cord AVMs. Factors for recurrent hemorrhage and the impact of endovascular treatment on prevention of recurrent hemorrhage remain to be confirmed. We aimed to assess recurrent hemorrhagic incidence of spinal cord AVMs and its prevention by endovascular treatment.

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“…Unfortunately, as a result of a lack of detailed information, a relatively large series of 15 patients with reportedly "metameric" AVMs was excluded. 5 This study largely focuses on the risk of hemorrhage from these lesions, which is only one of several sources of neurological morbidity from these AVMs. Mass effect from growing lesions (or residual lesions after partial treatment) or symptoms from venous hypertension requires better attention in a comprehensive analysis of the natural history of these lesions prior to and after treatment.…”

Section: Limitations Of This Studymentioning

confidence: 99%

Spinal juvenile (Type III) extradural-intradural arteriovenous malformations

Gross¹,

Du²

2014

SPI

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Object Owing to their rarity, demographics, natural history, and treatment, results for spinal juvenile (Type III) extradural-intradural arteriovenous malformations (AVMs) are frequently only provided in case report format. Methods A pooled analysis was performed utilizing the PubMed database through April 2013. Individualized patient data were extracted to elucidate demographics, hemorrhage risk, and treatment result information. Results Twenty-nine studies describing 51 patients were included. The mean age at presentation was 15.0 ± 10.5 years with a slight male predilection (63%, 1.7:1 sex ratio). Presentation modality included progressive deficits in 35%, hemorrhage in 31%, acute deficits not attributed to hemorrhage in 22%, and asymptomatic/incidental in 12% of patients. The annual hemorrhage rate was 2.1%; statistically significant risk factors for hemorrhage included presentation age (HR 0.39 [95% CI 0.18–0.87]) and associated aneurysms (HR 8.74 [95% CI 1.76–43.31]). Seventy-seven percent of patients underwent treatment; after a mean follow-up of 2.6 ± 3.2 years, 73% were improved, 10% were the same, and 17% were worse neurologically. Of 25 cases with described angiographic results, 8 lesions were obliterated (32%). Of these 25 patients, 8 had AVMs with associated aneurysms, and the aneurysm was obliterated in all 8 patients. Over the course of 57.9 patient-years of follow-up, including 55.3 patient-years for partially treated AVMs, no hemorrhages were described, reflecting a trend toward protection from hemorrhage after treatment (p = 0.12, likelihood ratio test). Conclusions Spinal juvenile (Type III) extradural-intradural AVMs commonly present symptomatically. Associated arterial aneurysms increase their hemorrhage risk, and protection from hemorrhage may be achieved from partial obliteration of these lesions, particularly if targeted toward associated aneurysms.

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Embolization with particles in thoracic intramedullary arteriovenous malformations: long-term angiographic and clinical results.

Cited by 123 publications

References 0 publications

Clinical features and treatment outcomes of the spinal arteriovenous fistulas and malformations

Clinical features and treatment outcomes of the spinal arteriovenous fistulas and malformations

The Preventive Effect of Endovascular Treatment for Recurrent Hemorrhage in Patients with Spinal Cord Arteriovenous Malformations

Spinal juvenile (Type III) extradural-intradural arteriovenous malformations

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