The spinal arteriovenous malformations (sAVMs) have been challenging entities to diagnose and treat. The small structure, important function, and complex vascular anatomy of the spinal cord increase the difficulty of treating sAVMs.
Objective
The combining holistic and local perspectives in the diagnosis and treatment of sAVMs were provided to teach spinal vascular anatomy and AVMs.
Methods and Results
A holistic view is to fully understand the anatomical and physiological effects of intracranial vascular lesions on the spinal cord circulatory system, as well as the anatomical and physiological effects of local sAVM on the entire spinal cord circulatory system, such as the relationship between lesions and surrounding blood vessels. The local view is to fully understand the macroscopic and microscopic vascular architectural characteristics of the lesion. The local view is closely related to the treatment of lesions and the holistic view is closely related to the effectiveness and side effects of treatment, which should be given attention in current clinical practice. The early diagnosis and treatment of sAVMs may improve outcomes.
Conclusion
A holistic and local perspective is essential to developing an understanding of the angioarchitecture, pathophysiology, natural history, treatment options, and classification of the different types of sAVMs.
GadotRGopakumarSWagnerK, et al.Foramen magnum dural arteriovenous fistula presenting with thoracic myelopathy: technical case report with 2-dimensional operative video. Oper Neurosurg (Hagerstown)2021; 21(1): E55–E59. DOI: 10.1093/ons/opab077.
2.
JellingerK. Vascular malformations of the central nervous system: a morphological overview. Neurosurg Rev1986; 9(3): 177–216. DOI: 10.1007/BF01743136.
3.
OzpinarAWeinerGMDucruetAF. Epidemiology, clinical presentation, diagnostic evaluation, and prognosis of spinal arteriovenous malformations. Handb Clin Neurol2017; 143: 145–152. DOI: 10.1016/B978-0-444-63640-9.00014-X.
4.
TakaiKEndoTSekiT, et al.Congestive myelopathy due to craniocervical junction arteriovenous fistulas mimicking transverse myelitis: a multicenter study on 27 cases. J Neurol2023; 270(3): 1745–1753. DOI: 10.1007/s00415-022-11536-7.
5.
LiZZhangHZhaoY, et al.Angioarchitectural features of arteriovenous fistulas at craniocervical junction predicting clinical presentation and unfavorable neurological function: insight from a multicenter cohort and pooled analysis. Neurosurg Rev2023; 46(1): 153. DOI: 10.1007/s10143-023-02057-6.
6.
MaYSongZWangY, et al.Clinical features, treatment strategies and outcomes of craniocervical junction arteriovenous fistulas: a cohort study of 193 patients. Stroke Vasc Neurol2023; 9: 18–29. DOI: 10.1136/svn-2023-002436.
7.
KringsT. Vascular malformations of the spine and spinal cord: anatomy, classification, treatment. Clin Neuroradiol2010; 20(1): 5–24. DOI: 10.1007/s00062-010-9036-6.
8.
KonaMPBuchKSinghJ, et al.Spinal vascular shunts: a patterned approach. AJNR Am J Neuroradiol2021; 42(12): 2110–2118. DOI: 10.3174/ajnr.A7312.
9.
BronnerMELeDouarinNM. Development and evolution of the neural crest: an overview. Dev Biol2012; 366(1): 2–9. DOI: 10.1016/j.ydbio.2011.12.042.
10.
FerchRDMorganMKSearsWR. Spinal arteriovenous malformations: a review with case illustrations. J Clin Neurosci2001; 8(4): 299–304. DOI: 10.1054/jocn.2000.0914.
11.
EndoTEndoHSatoK, et al.Surgical and endovascular treatment for spinal arteriovenous malformations. Neurol Med -Chir2016; 56(8): 457–464. DOI: 10.2176/nmc.ra.2015-0327.
12.
Rangel-CastillaLRussinJJZaidiHA, et al.Contemporary management of spinal AVFs and AVMs: lessons learned from 110 cases. Neurosurg Focus2014; 37(3): E14. DOI: 10.3171/2014.7.FOCUS14236.
13.
GrossBADuR. Spinal glomus (type II) arteriovenous malformations: a pooled analysis of hemorrhage risk and results of intervention. Neurosurgery2013; 72: 25–32.
14.
RosenblumBOldfieldEHDoppmanJL, et al.Spinal arteriovenous malformations: a comparison of dural arteriovenous fistulas and intradural AVM’s in 81 patients. J Neurosurg1987; 67(6): 795–802. DOI: 10.3171/jns.1987.67.6.0795.
15.
KalaniMYAhmedASMartirosyanNL, et al.Surgical and endovascular treatment of pediatric spinal arteriovenous malformations. World Neurosurg2012; 78(3-4): 348–354. DOI: 10.1016/j.wneu.2011.10.036.
16.
TakaiKTaniguchiM. Microsurgical resection of an intramedullary glomus arteriovenous malformation in the high cervical spinal cord: retrograde dissection techniques of the nidus located between spinal tracts. Acta Neurochir2015; 157(10): 1659–1664. DOI: 10.1007/s00701-015-2531-4.
17.
DeopujariCEDadachanjiMCSinghalBS. Cervical myelopathy caused by an intracranial dural arteriovenous fistula. Br J Neurosurg1995; 9(5): 671–674. DOI: 10.1080/02688699550040963.
18.
TakaiK. Spinal arteriovenous shunts: angioarchitecture and historical changes in classification. Neurol Med -Chir2017; 57(7): 356–365. DOI: 10.2176/nmc.ra.2016-0316.
19.
HuXYuanZLiangK, et al.Application of spinal subtraction and bone background fusion CTA in the accurate diagnosis and evaluation of spinal vascular malformations. AJNR Am J Neuroradiol2024; 45: 351–357. DOI: 10.3174/ajnr.A8112.
20.
LvXLiWLiY. Training residents and fellows in the procedure of diagnostic cervicocerebral angiography: techniques to avoid complications. Neurol India2018; 66(3): 652–656. DOI: 10.4103/0028-3886.232292.
21.
SpetzlerRFDetwilerPWRiinaHA, et al.Modified classification of spinal cord vascular lesions. J Neurosurg2002; 96(2 Suppl): 145–156. DOI: 10.3171/spi.2002.96.2.0145.
22.
BrinjikjiWNasrDMCloftHJ, et al.Spinal arteriovenous fistulae in patients with hereditary hemorrhagic telangiectasia: a case report and systematic review of the literature. Intervent Neuroradiol2016; 22(3): 354–361. DOI: 10.1177/1591019915623560.
23.
HiramatsuMSugiuKIshiguroT, et al.Angioarchitecture of arteriovenous fistulas at the craniocervical junction: a multicenter cohort study of 54 patients. J Neurosurg2018; 128(6): 1839–1849. DOI: 10.3171/2017.3.JNS163048.
24.
PalPRaySChakrabortyS, et al.Cobb syndrome: a rare cause of paraplegia. Ann Neurosci2015; 22(3): 191–193. DOI: 10.5214/ans.0972.7531.220312.
25.
GoyalNPatilAKKuldeepR, et al.Need to incorporate endovascular neurosurgery in neurosurgery curriculum in India: stay abreast or be left behind. Neurol India2023; 71(6): 1222–1225. DOI: 10.4103/0028-3886.391393.
26.
KochMJStapletonCJAgarwallaPK, et al.Open and endovascular treatment of spinal dural arteriovenous fistulas: a 10-year experience. J Neurosurg Spine2017; 26(4): 519–523. DOI: 10.3171/2016.9.SPINE16394.
De GradoAManfrediCBrugneraA, et al.Watch brain circulation in unexplained progressive myelopathy: a review of Cognard type V arterio-venous fistulas. Neurol Sci2023; 44: 3457–3480. DOI: 10.1007/s10072-023-06870-1.
29.
SaliouGTejATheaudinM, et al.Risk factors of hematomyelia recurrence and clinical outcome in children with intradural spinal cord arteriovenous malformations. AJNR Am J Neuroradiol2014; 35(7): 1440–1446. DOI: 10.3174/ajnr.A3888.
30.
LeeYJTerbruggeKGSaliouG, et al.Clinical features and outcomes of spinal cord arteriovenous malformations: comparison between nidus and fistulous types. Stroke2014; 45(9): 2606–2612. DOI: 10.1161/STROKEAHA.114.006087.
31.
AminoffMJLogueV. The prognosis of patients with spinal vascular malformations. Brain1974; 97: 211–218.
32.
KitamuraGJacobsonJPZourosA, et al.Improved neurological function in a paediatric patient following Onyx embolization of a cervical glomus arteriovenous malformation. J Neurointerventional Surg2010; 2(4): 394–398. DOI: 10.1136/jnis.2009.001453.
33.
GekkaMSekiTHidaK, et al.Surgical management of combined intramedullary arteriovenous malformation and perimedullary arteriovenous fistula within the hybrid operating room after five years of performing focus fractionated radiotherapy: case report. Neurol Med -Chir2014; 54(11): 936–940. DOI: 10.2176/nmc.cr.2014-0143.
34.
Rangel-CastillaLSpetzlerRF. Microsurgical resection of cervical spinal arteriovenous malformation: the pial resection technique. Neurosurg Focus2014; 37(Suppl 2): 12. DOI: 10.3171/2014.V3.FOCUS14375.
35.
OhlssonMConsoliADiMariaF, et al.Natural history and management of spinal cord arteriovenous shunts in pregnancy: a monocentric series of 10 consecutive cases with emphasis on endovascular treatment. J Neuroradiol2022; 49(6): 401–408. DOI: 10.1016/j.neurad.2020.09.006.
36.
RodeschGHurthMAlvarezH, et al.Classification of spinal cord arteriovenous shunts: proposal for a reappraisal--the Bicêtre experience with 155 consecutive patients treated between 1981 and 1999. Neurosurgery2002; 51(2): 374–379.
37.
LvXLiYYangX, et al.Endovascular embolization for symptomatic perimedullary AVF and intramedullary AVM: a series and a literature review. Neuroradiology2012; 54: 349–359.
38.
LvXYangXLiY, et al.Dural arteriovenous fistula with spinal perimedullary venous drainage. Neurol India2011; 59(6): 899–902. DOI: 10.4103/0028-3886.91374.
39.
VargasMIDelattreBMABotoJ, et al.Advanced magnetic resonance imaging (MRI) techniques of the spine and spinal cord in children and adults. Insights Imaging2018; 9(4): 549–557. DOI: 10.1007/s13244-018-0626-1.
40.
LvXLiuPLiY. Pre-existing, incidental and hemorrhagic AVMs in pregnancy and postpartum: gestational age, morbidity and mortality, management and risk to the fetus. Intervent Neuroradiol2016; 22(2): 206–211.
41.
GranataFAlafaciCGiacobbeA, et al.Endovascular treatment of cerebral arteriovenous malformation bleeding during pregnancy. A case report. NeuroRadiol J2010; 23(4): 473–478. DOI: 10.1177/197140091002300419.
