Spinal cord vascular malformations

Book chapters and journal articles dealing with spinal cord vascular malformations often reference Otto Hebold and Julius Gaupp, but frequently misrepresent the observations published by the two German authors in the late 19th century. The purpose of this paper is to provide a better appreciation of these important contributions based on abridged translations of original documents set in their historical context, notably regarding the landmark works of Brasch, Raymond and Cestan, and Lindenmann. It is concluded that Gaupp offered the first reliable description of a perimedullary arteriovenous fistula while the lesion reported by Hebold was not a spinal vascular malformation.

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Introduction: Spinal Vascular Malformations

Neurosurgical FOCUS ◽

10.3171/foc.2009.26.1.e1 ◽

2009 ◽

Vol 26 (1) ◽

pp. E1 ◽

Cited By ~ 2

Author(s):

Edward H. Oldfield

Keyword(s):

Spinal Cord ◽

Vascular Malformations ◽

Vascular Lesions ◽

Successful Management ◽

Anatomical Features ◽

Spinal Vascular Malformations ◽

Cord Injury ◽

Selective Arteriography ◽

The 1960S ◽

Made In

From the earliest observations of spinal vascular malformations, successful management has been challenging. Initially the challenges were diagnosing, understanding, and treating these lesions. They were originally considered all to be the same, or at least to be a single general type, of disease. With the introduction of selective spinal arteriography in the 1960s and more recently with the introduction and widespread use of MR imaging, the initial challenge of diagnosing spinal vascular malformations was overcome, and significant progress has been made in understanding their anatomy as well as the pathophysiology that underlies the myelopathy commonly associated with them. The anatomical features defined by selective arteriography and the observations permitted with the operating microscope ultimately led to distinctions between the major categories of the vascular lesions affecting the spinal cord; these distinctions were based on the lesions' anatomy, epidemiology, and the mechanism of spinal cord injury.

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Multifocal and Metameric Spinal Cord Arteriovenous Malformations

Interventional Neuroradiology ◽

10.1177/159101999900500105 ◽

1999 ◽

Vol 5 (1) ◽

pp. 27-34 ◽

Cited By ~ 27

Author(s):

Y. Matsumaru ◽

S. Pongpech ◽

J. Laothamas ◽

H. Alvarez ◽

G. Rodesch ◽

...

Keyword(s):

Spinal Cord ◽

Neural Crest ◽

Arteriovenous Malformations ◽

Vascular Malformations ◽

Vascular Lesions ◽

Frequent Type ◽

Associated Lesions ◽

Neural Crest Origin ◽

Cord Lesion

We describe 19 (16.0%) multiple vascular malformations (AVMs) in 119 spinal cord arteriovenous malformations (SCAVMs). The associated lesions were eight vertebral vascular malformations, two cutaneous, four limbs, four radicular AVMs, three bifocal SCAVMs; one patient had a bifocal cord lesion associated with vertebral and limb localisations. Various syndromic associations were seen: nine Cobb, two Klippel-Trenaunay-Weber, one Parkes Weber. An additional subgroup of unclassified associations is constituted by seven cases with bifocal intradural uni or multimetamerk lesions. In our SCAVMs series, the incidence of multiple vascular lesions is high, in particular multifocal intradural malformations. Metameric distribution is the most frequent type of multiplicity. Identification of the myelomeric level involved in SCAVM allows segmental link between various lesions of mesodermal or neural crest origin to be discussed.

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The use of 3D computer graphics in the diagnosis and treatment of spinal vascular malformations

Journal of Neurosurgery Spine ◽

10.3171/2011.8.spine11155 ◽

2011 ◽

Vol 15 (6) ◽

pp. 654-659 ◽

Cited By ~ 27

Author(s):

Keisuke Takai ◽

Taichi Kin ◽

Hiroshi Oyama ◽

Akira Iijima ◽

Masaaki Shojima ◽

...

Keyword(s):

Spinal Cord ◽

Computer Graphics ◽

Dura Mater ◽

Vascular Malformations ◽

Case Series ◽

University Hospital ◽

Diagnosis And Treatment ◽

Fisher Exact Test ◽

Imaging Method ◽

Spinal Vascular Malformations

Object Digital subtraction (DS) angiography is the gold standard for diagnosing spinal vascular malformations. Recently, multidetectorrow spiral CT and contrast-enhanced MR angiography have been introduced as screening examinations before DS angiography. These methods, however, do not always determine the accurate location of an arteriovenous shunt because the resulting images lack information about the spinal cord or the dura mater. Methods Between April 2009 and December 2010, 13 patients underwent imaging evaluations for spinal vascular malformations at the authors' university hospital. This group included 8 patients with spinal dural arteriovenous fistulas (AVFs), 3 with perimedullary AVFs, and 2 with intramedullary arteriovenous malformations. Using data from these patients, the authors attempted to develop 3D computer graphics (CG) based upon the fusion of 3D rotational angiography and postmyelographic CT. They subsequently verified the accuracy of this imaging method. Ten of these 13 patients underwent surgical treatment for their lesions (11 AVFs), and for these 11 lesions the authors compared the diagnoses obtained using 3D CG with those obtained using conventional DS angiography. Results In all 13 cases, 3D CG images of the spinal lesions were successfully developed using the patients' actual data. Four (36%) of 11 AVFs were correctly identified using DS angiography, whereas 10 (91%) were correctly identified using 3D CG. Results from 3D CG of spinal AVFs corresponded well with operative findings, and 3D CG was significantly better than conventional DS angiography at predicting AVF location (p = 0.024, Fisher exact test). Conclusions To the authors' knowledge, this is the first reported case series in which 3D CG of spinal vascular malformations was used to provide simultaneous, stereoscopic visualization of the spinal vascular system, spinal cord, dura mater, and bone. The 3D CG method provides precise visual images for the diagnosis and treatment of these lesions.

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