Embolisation of Spinal Cord Arteriovenous Malformations with Glue through the Anterior Spinal Axis

Abstract

We reviewed the clinical and morphological results of spinal cord arteriovenous malformations (SCAVMs) embolised with acrylic glue through the anterior spinal axis (ASA), and assessed the anatomical guidelines that should be followed to safely embolise the ASA.

Twenty consecutive SCAVMS seen between 1982 and 1996 were reviewed. There were 15 lesions in the thoracolumbar cord and 5 in the cervical cord. Haemorrhage was the revealing symptom in 13 patients (65%). Embolisation through the ASA was done in 19 SCAVMs (2 with PVA particles in our early experience and 17 with Histoacryl*). One patient was not embolised because of a spastic reaction of the ASA that led to secondary subtotal thrombosis of the SCAVM without neurological deficit.

The ASA was chosen as arterial approach to the AVM because it was the only feeder to the lesion (1 case) and/or because it was one of the accessible pedicles harbouring particular angioarchitectural weakness points. Vascular occlusion was always indicated and performed following precise anatomical analysis of the lesion and of the regional vascular disposition. In all cases embolisation of the ASA feeders to a SCAVM was performed under general anaesthesia, without any evoked potentials or provocative tests. However, 3/19 (16%) patients presented transient worsening of their clinical condition. Permanent morbidity occurred in 2/19 patients (11%): one patient cured from a cervical intramedullary AVM presents mainly a deltoid palsy, the other with a thoracic intramedullary AVM has worsened his paraparesis. At follow-up, 6/19 patients (32%) are neurologically normal and 10/19 (53%) have improved their neurological conditions and deficits. One patient embolised recently is currently stable but is expected to improve. No embolised patient bled or rebled during follow-up. Neurological symptoms recurred in one patient who had been stable for one year after his first embolisation.

For an experienced interventional neuroradiology team, embolisation of SCAVMs through the ASA is feasible with acrylic glue with good clinical results. Proper analysis of the vascular architecture is mandatory to select the cases that can benefit from such approach.