Embolization of Spinal Cord AVMs with ASA Supply

Abstract

Treatment of spinal cord AVMs is always challenging and leads to high risks even with endovascular or microsurgical approach. Risks arise mainly when an “intramedullary” spinal cord AVM fed by anterior spinal artery (ASA) needs to be treated. Superselective catheterization technique and embolization agents represent important risk factors. The aim of this report is to evaluate the results and limits of embolization therapy of these malformations on the basis of our experience. Since 1996 we treated 51 spinal vascular malformations, 29 were true SCAVMs. The main ASA supply was observed in 17 cases. All were intramedullary AVM with “nidus” type appearance. Complete embolization was achieved in 23.5% of cases. Complications related to the procedure were observed in 28% of cases. Our results confirm that ASA embolization is at high risk of hemorrhage and ischemia. We believe that this technique should be reserved for patients with previous hemorrhage and when a high risk of hemorrhagic event is recognized. Moreover, a poor natural history of this illness suggests that conservative treatment is not always recommended. In these cases a fractionated superselective embolization to reduce hemorrhagic events could be a good option.