Percutaneous embolization of spinal cord arteriovenous malformations

Jl, Doppman; G, Di Chiro; Ak, Ommaya

doi:10.3171/jns.1971.34.1.0048

Cited by 95 publications

(8 citation statements)

References 21 publications

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“…[7][8][9][10]13 However, embolic occlusion with biologically inert particulate matter, such as PVA, only provides temporary occlusion. Early recanalization and recurrent myelopathy have been the rule rather than the exception.…”

Section: Embolization Of the Avmmentioning

confidence: 99%

“…11,15,16,20 In the past two decades significant advances have been made in the understanding of the anatomy, pathophysiology, classification, and management of these lesions. [1][2][3]6,8,9,11,12,14 Ideal treatment of them should permanently eliminate venous congestion of the spinal cord without damaging the spinal cord or its blood supply. 1,11,12,15,16,20 Although currently recognized management options include interruption of the intradural draining vein, complete excision of the dural AVF, and embolization, the optimum management of spinal dural AVFs is unproven.…”

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confidence: 99%

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Surgical interruption of intradural draining vein as curative treatment of spinal dural arteriovenous fistulas

Afshar

Doppman²,

Oldfield³

1995

Journal of Neurosurgery

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138

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To establish if interruption of the intradural draining spinal vein or surgical excision are curative treatments for spinal dural arteriovenous fistulas (AVFs), the medical records and radiographic studies of 19 patients with spinal dural AVFs and progressive myelopathy were reviewed. Spinal arteriograms were obtained before and within 2 weeks after surgery in 19 patients, and after a delay of 4 months or more in 11 patients. The mean clinical and arteriographic follow up was at 37 and 35 months, respectively. In the 11 patients who underwent excision of the dural AVF there was no evidence of a residual lesion upon immediate or delayed postoperative arteriography. Surgery in eight patients consisted of simple interruption of the intradural draining vein as it entered the subarachnoid space. In six of these patients the vein draining the AVF intrathecally provided the only venous drainage of the AVF. In these six patients there was no immediate (six of six) or delayed (four of six) arteriographic evidence of residual or recurrent flow through the AVF. Two patients had an AVF with both intra- and extradural venous drainage; after intradural division of the draining vein there was residual flow through the AVF into the extradural venous system. In one of these two patients intrathecal venous drainage was reestablished, which required additional therapy. In the other patient the extradural AVF spontaneously thrombosed and was not evident on delayed follow-up arteriography. In patients with spinal dural AVFs with only intrathecal medullary venous drainage, which includes most patients with these lesions, surgical interruption of the intradural draining vein provides lasting and curative treatment. In patients with both intra- and extradural drainage of the AVF, complete excision of the fistula or interruption of the intra- and extradural venous drainage of the fistula is indicated. In patients in whom a common vessel supplies the spinal cord and the dural AVF, simple surgical interruption of the vein draining the AVF is the treatment of choice, as it provides lasting obliteration of the fistula and it is the only treatment that does not risk arterial occlusion and cord infarction. Simple interruption of the venous drainage of a spinal dural AVF provides lasting occlusion of the fistula, as it does for cranial dural AVFs, if all pathways of venous drainage are interrupted. This result provides further evidence that the venous approach to the treatment of dural AVFs can be used successfully.

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Section: Embolization Of the Avmmentioning

confidence: 99%

mentioning

confidence: 99%

Surgical interruption of intradural draining vein as curative treatment of spinal dural arteriovenous fistulas

Afshar

Doppman²,

Oldfield³

1995

Journal of Neurosurgery

Self Cite

138

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“…Since our report in 1970 of the first embolization of neoplasms of the head and neck, s several publications have appeared on this subject, s, 4,12,18 In this paper, we present the long-term clinical follow-up on our patient material and describe a new methodology of embolization which we believe emphasizes safety and effectiveness.…”

mentioning

confidence: 94%

Therapeutic percutaneous embolization for extra-axial vascular lesions of the head, neck, and spine

Hilal¹,

Michelsen²

1975

Journal of Neurosurgery

158

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Therapeutic percutaneous embolization of extra-axial vascular tumors and arteriovenous malformations was performed 41 times in 27 patients. Twenty-one patients (78%) had a clinically favorable result. In 11 of these patients, the procedure was preoperative and caused a dramatic reduction of surgical blood loss. In the remaining 10 patients with a favorable result, therapeutic embolization alone resulted in a significant clinical amelioration documented by a detailed follow-up varying from 2 to 5 years. In patients with uncontrollable epistaxis, the procedure was life-saving. The guidelines and instrumentation for a safe and effective technique are presented, based on the authors' experience with more than 100 cases of vascular lesions of the brain and spinal cord. A low-viscosity silicone polymer was developed by the authors and used clinically as an intravascular adhesive for the embolization of vascular tumors.

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“…Endovascular options have evolved significantly since the first report in 1971 by Doppman et al 21 of occlusion of spinal cord AVMs. From proximal arterial ligations it evolved to superselective injections of permanent embolic material in specific points of the AVM, being able to preserve important blood supply to the cord.…”

Section: Spinal Cord Avmsmentioning

confidence: 99%

Spinal cord vascular shunts: spinal cord vascular malformations and dural arteriovenous fistulas

Costa

Dehdashti²,

terBrugge

2009

FOC

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Object Spinal cord vascular malformations are rare, fascinating lesions. In this paper, the authors' goal was to demonstrate how these lesions, more specifically spinal cord arteriovenous malformations and dural arteriovenous fistulas, are assessed, classified, and managed at their institution. They also highlight some aspects of classification and management that may be different from the views of others. Methods The authors reviewed the 20-year experience at the senior author's institution regarding the management of spinal cord vascular malformations. They discuss the management, surgical and endovascular treatment results, and the classification that resulted from the combined experience of 3 major reference centers. Results The accumulated knowledge on embryological and pathophysiological aspects in such a rare disease resulted in a more global, patient-oriented (and not radiologically oriented) approach to spinal cord shunts. Conclusions The multiple classifications proposed for spinal cord vascular malformations reflect the continuous advancement of the authors' understanding. They adopt a classification based on new physiological and genetic data that treats these lesions as expressions of more complex disease processes and not simply a morphological target, with direct impact on therapeutic options.

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Percutaneous embolization of spinal cord arteriovenous malformations

Cited by 95 publications

References 21 publications

Surgical interruption of intradural draining vein as curative treatment of spinal dural arteriovenous fistulas

Surgical interruption of intradural draining vein as curative treatment of spinal dural arteriovenous fistulas

Therapeutic percutaneous embolization for extra-axial vascular lesions of the head, neck, and spine

Spinal cord vascular shunts: spinal cord vascular malformations and dural arteriovenous fistulas

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