58 Spinal Arteriovenous Malformations

Abstract

Spinal arteriovenous malformations (AVMs) are rare, complex vascular lesions. Understanding of these lesions has increased thanks to neuroimaging technology. Spinal AVMs are classified into four types: dural or intradural arteriovenous fistula (AVF; type 1) are the most common; intramedullary or glomus AVMs (type 2) can be compact or diffuse; metameric or extradural–intradural AVMs (type 3) involve all tissue types; and perimedullary AVFs (type 4) that also include conus medullaris AVM type. Patients can present with back pain, motor/sensory deficits, myelopathy/radiculopathy, or subarachnoid hemorrhage. Most of the symptoms are related to venous hypertension. Computed tomography (CT), CT angiogram, and magnetic resonance imaging (MRI) of the spinal cord are the initial evaluation imaging. Digital subtraction angiography is the gold standard for spinal AVM visualization and characterization. Both endovascular embolization and microsurgical resection are good options. Microsurgical resection has less incidence of recurrence. The goal for both modalities is to eliminate the fistulous portion of the AVM. Spinal AVMs should be treated on an individual basis in a tertiary center with a group of cerebrovascular and endovascular neurosurgeons. Appropriate clinical and radiological follow-up is mandatory in all spinal AVMs.