Spinal vascular malformations: Angiographic evaluation and endovascular management

Research output: Chapter in Book/Report/Conference proceedingChapter

Abstract

Spinal vascular malformations (SVM) are classified based on their location (intramedullary, perimedullary, radicular, extradural) and flow pattern (high-flow, low-flow, no arteriovenous shunt). High-flow SVMs are generally congenital lesions diagnosed in children and young patients without gender predominance. They present with hemodynamic disturbances, mass effect, or hemorrhages, but may also be discovered incidentally. Low-flow SVMs tend to be acquired lesions presenting in older men with progressive myelopathy caused by spinal venous hypertension. They are rarely associated with vascular syndromes but may accompany prothrombotic conditions. The sensitivity and specificity of conventional MRI are excellent for high-flow SVMs but poor for low-flow lesions, which are frequently diagnosed with extensive delays reducing the potential for favorable outcomes. The sensitivity of advanced MRI techniques remains unclear, notably for the detection of low-flow shunts without flow voids on conventional MRI. Catheter angiography remains the gold standard modality for the evaluation of the spinal vasculature and its disorders. SVMs can be treated by surgical or endovascular means. Initially plagued by high recurrence rates due to inadequate embolization material, endovascular techniques represent nowadays a valid alternative to surgery, thanks notably to the introduction of liquid embolic agents.

Original languageEnglish (US)
Title of host publicationHandbook of Clinical Neurology
PublisherElsevier B.V.
Pages267-304
Number of pages38
DOIs
StatePublished - Jan 2021

Publication series

NameHandbook of Clinical Neurology
Volume176
ISSN (Print)0072-9752
ISSN (Electronic)2212-4152

Keywords

  • Endovascular therapy
  • Imaging
  • Liquid embolic agent
  • Spinal angiography
  • Spinal arteriovenous fistulas
  • Spinal arteriovenous malformations
  • Spinal vascular anomalies
  • Vascular myelopathy

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

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