Intrinsic Spinal Cord Arteriovenous Malformations

Rodesch, Georges; Hurth, M; Tadié, M; David, Philippe; Gaillard, Stéphan; Lasjaunias, P.

doi:10.1177/19714009090220s120

Cited by 4 publications

(1 citation statement)

References 229 publications

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“…Medical innovations such as the Seldinger technique [17] and subtraction angiography [18] drove the development of image‐guided therapy via minimally invasive X‐ray‐guided procedures for biopsies, drain placement, and angiography and eventually replaced a large range of vascular and surgical procedures. Interventional neuroradiology had its major breakthrough in the last decade of the 19th century propelled largely by the glue embolization for brain Arteriovenous malformations (AVMs) [19], and the Gugliemi detachable coils [20] that made coiling for brain aneurysms and fistulas safe and effective.…”

Section: Evolution Of Stroke Treatmentmentioning

confidence: 99%

Endovascular thrombectomy for acute ischemic stroke

et al. 2022

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This review describes the evolution of endovascular treatment for acute ischemic stroke, current state of the art, and the challenges for the next decade. The rapid development of endovascular thrombectomy (EVT), from the first attempts into standard of care on a global scale, is one of the major achievements in modern medicine. It was possible thanks to the establishment of a scientific framework for patient selection, assessment of stroke severity and outcome, technical development by dedicated physicians and the MedTech industry, including noninvasive imaging for patient selection, and radiological outcome evaluation. A series of randomized controlled trials on EVT in addition to intravenous thrombolytics, with overwhelmingly positive results for anterior circulation stroke within 6 h of onset regardless of patient characteristics with a number needed to treat of less than 3 for any positive shift in outcome, paved the way for a rapid introduction of EVT into clinical practice. Within the “extended” time window of 6–24 h, the effect has been even greater for patients with salvageable brain tissue according to perfusion imaging with a number needed to treat below 2. Even so, EVT is only available for a small portion of stroke patients, and successfully recanalized EVT patients do not always achieve excellent functional outcome. The major challenges in the years to come include rapid prehospital detection of stroke symptoms, adequate clinical and radiological diagnosis of severe ischemic stroke cases, enabling effective recanalization by EVT in dedicated angiosuites, followed by personalized post‐EVT stroke care.

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Section: Evolution Of Stroke Treatmentmentioning

confidence: 99%

Endovascular thrombectomy for acute ischemic stroke

et al. 2022

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Evaluation of Spinal Vascular Malformations Using 64-Slice CT-Angiography

Medenica

Prstojević²,

Vuckovic³

2011

Neuroradiol J

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Spinal vascular malformations are rare but they pose a great risk of disability for patients. Although spinal DSA is the gold standard in the diagnostic evaluation of these vascular anomalies, it is an invasive, technically complicated and time-consuming method. The purpose of this report is to add to the knowledge of CT angiography as a non-invasive method that may become an alternative diagnostic tool in the imaging of spinal vascular anomalies.

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Intradural spinal cord arteriovenous shunts in a personal series of 210 patients: novel classification with emphasis on anatomical disposition and angioarchitectonic distribution, related to spinal cord histogenetic units

Mizutani

Consoli

Maria

et al. 2021

Journal of Neurosurgery: Spine

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OBJECTIVE Few classifications of intradural spinal arteriovenous shunts (ID-SAVSs) have considered their anatomical localization in relation to their phenotype and angioarchitectonics. The authors propose another vision of ID-SAVSs allowing a reappraised classification based on analysis of the anatomical disposition, angioarchitecture, and histogenetic location of these vascular malformations. METHODS The radiological and clinical records of 210 patients with ID-SAVSs were retrospectively reviewed, considering their localization, vascular architectonics, and correlation with the 5 histogenetic units of the spinal cord. Among these, 183 files with complete data allowed precise analysis of the ID-SAVSs. RESULTS Among these 183 files (162 and 21 cases with single and multiple lesions, respectively), different entities were identified: 13 pial macro arteriovenous fistulas (MAVFs), 92 pial micro arteriovenous fistulas (mAVFs), 33 superficial pial niduses, and 69 intramedullary niduses. Thirteen sulcal shunts (either fistulas or niduses) were considered subtypes of pial lesions. Among the 21 multiple cases, 11 were monomyelomeric while 10 were multimyelomeric. Pial lesions, either fistulas or niduses, were dominantly vascularized by pial arteries (anterior or posterior depending on the localization of the shunt) and occasionally (except for MAVFs) by transmedullary arteries. Pial niduses occasionally extended into the funiculus by recruiting intrinsic veins or by extension of the nidus itself inside the white matter. Intramedullary niduses were always vascularized by both centrifugal and centripetal feeders, respectively, from sulcal arteries (SAs) and pial arteries. Sulcal lesions are pial lesions located within the ventral median sulcus and vascularized by SAs and veins. Single or multiple ID-SAVSs can be part of various syndromes such as hereditary hemorrhagic telangiectasia, Parkes-Weber, RASA1, CLOVES, and spinal arteriovenous metameric syndromes. Histogenetic analyses revealed a specific distribution of each ID-SAVS in the 5 histogenetic units of the spinal cord: intramedullary niduses were found almost equally from cervical to thoracic units, while MAVFs and mAVFs were mostly found from thoracic to postcrural ones. Pial niduses showed intermediate features between intramedullary and fistulous lesions and were mostly distributed from brachial to crural segments. CONCLUSIONS Precise analysis of the anatomical disposition of ID-SAVSs in relation to functional histogenetic units allows a better understanding of these lesions and improved therapeutic management.

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Intrinsic Spinal Cord Arteriovenous Malformations

Cited by 4 publications

References 229 publications

Endovascular thrombectomy for acute ischemic stroke

Endovascular thrombectomy for acute ischemic stroke

Evaluation of Spinal Vascular Malformations Using 64-Slice CT-Angiography

Intradural spinal cord arteriovenous shunts in a personal series of 210 patients: novel classification with emphasis on anatomical disposition and angioarchitectonic distribution, related to spinal cord histogenetic units

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