Vascular Myelopathies-Vascular Malformations of the Spinal Cord: Presentation and Endovascular Surgical Management

Abstract

Spinal cord vascular malformations are often a cause of spinal myelopathy. Endovascular surgical approaches to spinal cord vascular malformations have become an important adjunct and often the primary treatment of these disorders. Spinal cord vascular malformations may be divided into several categories based on their anatomy and location. They may present with a wide range of symptoms far removed from the vascular pathology. Early recognition and treatment can effect a better outcome and often reverse presenting neurologic deficits. Emerging magnetic resonance imaging techniques allow visualization of flow voids, some vascular anatomy, and intramedullary pathology and are a good screening modality. However, selective diagnostic spinal angiography remains the study of choice to diagnose and elaborate on the anatomy and potential treatment protocols. Rapidly evolving endovascular techniques and technology are revolutionizing the treatment of vascular pathology in the central nervous system, either as an adjunct to traditional neurosurgical techniques or as definitive therapy. We review the diagnosis and treatment options for spinal cord vascular malformations.

In parallelinterconnectivity of the dorsal longitudinal anastomotic vessels requires both VEGF signaling and circulatory flow

“…The DLAVs communicate in series with cephalic vessels (Isogai et al, 2001;Walls et al, 2008), are thought to be precursors for the perineural vascular plexus that later surrounds and invades the spinal cord (Walls et al, 2008;Bautch and James, 2009), and are likely to guide the migration of the neighboring dorsal lymphatic vasculature (see Hogan et al, 2009a;Hogan et al, 2009b;Bussmann et al, 2010). Thus, studying how the DLAV plexus arises and remodels should also illuminate the etiology of spinal cord vascular malformations, a major cause of debilitating myelopathies (Caragine et al, 2002).…”

Electroconductive polymeric nanowire templates facilitates in vitro C17.2 neural stem cell line adhesion, proliferation and differentiation

“…For example, diseases such as polio, measles or herpes may cause myelitis which is inflammation of the spinal cord[1]. Vascular myelopathy is another type of spinal cord disorder and often arises from spinal cord vascular malformations[2]. When spinal cord disorders are caused by trauma, it is referred to as spinal cord injury (SCI)[3].…”

Endovascular management of spinal dural arteriovenous fistulas

“…12,30,36,59,63 For reasons yet to be fully determined, there is a preponderance of this diagnosis in males. 12,30,36,59,63 Although a gradual progression in clinical symptoms has been reported in the majority of patients with spinal DAVFs, a more punctuated, stepwise deterioration has been reported in some patients. 32,61 At the time of diagnosis, many patients have already experienced a considerable progression in the severity of symptoms, and approximately half of all patients report motor disturbances, including weakness and gait abnormalities.…”

“…32 Another common finding on MR imaging is the presence of flow voids in 35% of patients, which are believed to represent blood flow within dilated medullary veins. 12,21,29 More recently, MR angiography has been used as a diagnostic modality for spinal DAVFs, demonstrating abnormal intradural vessels in 100% of patients according to 1 study. 11 Magnetic resonance angiography has also been reported as a sensitive technique in the assessment of residual blood flow following treatment for spinal DAVFs.…”