About our paper “Intradural spinal cord arteriovenous shunts in the pediatric population: natural history, endovascular management and follow-up”

Abstract BACKGROUND: Reports of cervical perimedullary arteriovenous shunt (PMAVS) are limited, and treatment strategies have not been established. OBJECTIVE: To describe angioarchitecture and optimal treatment strategies for cervical PMAVS. METHODS: We treated 22 patients with cervical PMAVS between 2000 and 2012 (8 women and 14 men; age, 9-80 years). According to the classification, our patients included type IVa (4 patients), type IVb (16 patients), and type IVc (2 patients). Seventeen patients presented with subarachnoid hemorrhage. RESULTS: A total of 41 shunting points were localized in 22 patients, of which 34 points were located ventral or ventrolateral to the spinal cord. The anterior spinal artery (ASA) contributed to the shunts in 16 patients. Aneurysm formation was identified in 8 patients. Endovascular treatment was attempted in 3 patients, resulting in complete obliteration in 1 patient (type IVc). Overall, 21 patients underwent open surgery. An anterior approach with corpectomy was elected for 2 patients; the other 19 patients underwent the posterior approaches using indocyanine green videoangiography, intraoperative angiography, endoscopy (8 patients), and neuromonitoring. Twenty patients were rated as having a good recovery at 6 months after surgery. No recurrence was observed in any patients during the follow-up (mean, 59.7 months). CONCLUSION: Shunting points of the cervical PMAVS were predominantly located ventral or ventrolateral to the spinal cord and were often fed by the ASA. Even for ventral lesions, posterior exposure assisted with neuromonitoring and endoscopy, and intraoperative angiography provided a view sufficient to understand the relationships between the shunts and the ASA and contributed to good surgical outcomes.

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Natural History and Clinical Outcomes of Paravertebral Arteriovenous Shunts

Stroke ◽

10.1161/strokeaha.120.033963 ◽

2021 ◽

Author(s):

Yueshan Feng ◽

Jiaxing Yu ◽

Jiankun Xu ◽

Chuan He ◽

Lisong Bian ◽

...

Keyword(s):

Natural History ◽

Clinical Outcomes ◽

Clinical Intervention ◽

Type A ◽

Neurological Deficits ◽

Type B ◽

Deterioration Rate ◽

Arteriovenous Shunts ◽

Spinal Segments

Background and Purpose: Paravertebral arteriovenous shunts (PVAVSs) are rare. Whether the intradural venous system is involved in drainage may lead to differences in clinical characteristics through specific pathophysiological mechanisms. This study aims to comprehensively evaluate the natural history and clinical outcomes of PVAVSs with or without intradural drainage. Methods: Sixty-four consecutive patients with PVAVSs from 2 institutes were retrospectively reviewed. Lesions were classified as type A (n=28) if the intradural veins were involved in drainage; otherwise, they were classified as type B (n=36). The clinical course from initial presentation to the last follow-up was analyzed. Results: The patients with type A shunts were older at presentation (52.5 versus 35.5 years, P <0.0001) and more likely to have lower spinal segments affected than patients with type B PVAVSs (67.8% versus 13.9%, P =0.00006). After presentation, the deterioration rates related to gait and sphincter dysfunction were significantly higher in patients with type A than type B shunts (gait dysfunction: 71.8%/y versus 17.0%/y, P =0.0006; sphincter dysfunction: 63.7%/y versus 11.3%/y, P =0.0002). According to the angiogram at the end of the latest treatment, 79% of type A and 75% of type B PVAVSs were completely obliterated. If the lesions were partially obliterated, a significantly higher clinical deterioration rate was observed in patients with type A shunts than those with type B shunts (69.9%/y versus 3.2%/y, P =0.0253). Conclusions: Type A PVAVSs feature rapid progressive neurological deficits; therefore, early clinical intervention is necessary. For complex lesions that cannot be completely obliterated, surgical disconnection of all refluxed radicular veins is suggested.

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Spinal Cord Arteriovenous Shunts in the Pediatric Population

Textbook of Pediatric Neurosurgery ◽

10.1007/978-3-319-72168-2_120 ◽

2020 ◽

pp. 2577-2598

Author(s):

Arturo Consoli ◽

Georges Rodesch

Keyword(s):

Spinal Cord ◽

Pediatric Population ◽

Arteriovenous Shunts

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Spinal Cord Arteriovenous Shunts in the Pediatric Population

Textbook of Pediatric Neurosurgery ◽

10.1007/978-3-319-31512-6_120-1 ◽

2017 ◽

pp. 1-27

Author(s):

Arturo Consoli ◽

Georges Rodesch

Keyword(s):

Spinal Cord ◽

Pediatric Population ◽

Arteriovenous Shunts

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Natural history and management of spinal cord arteriovenous shunts in pregnancy: A monocentric series of 10 consecutive cases with emphasis on endovascular treatment

Journal of Neuroradiology ◽

10.1016/j.neurad.2020.09.006 ◽

2020 ◽

Author(s):

Marcus Ohlsson ◽

Arturo Consoli ◽

Federico DiMaria ◽

Alessandro Sgreccia ◽

Georges Rodesch

Keyword(s):

Spinal Cord ◽

Natural History ◽

Endovascular Treatment ◽

Arteriovenous Shunts ◽

In Pregnancy

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Spinal Cord Intradural Arteriovenous Fistulae: Anatomic, Clinical, and Therapeutic Considerations in a Series of 32 Consecutive Patients Seen between 1981 and 2000 with Emphasis on Endovascular Therapy

Neurosurgery ◽

10.1227/01.neu.0000181314.94000.cd ◽

2005 ◽

Vol 57 (5) ◽

pp. 973-983 ◽

Cited By ~ 91

Author(s):

Georges Rodesch ◽

Michel Hurth ◽

Hortensia Alvarez ◽

Marc Tadie ◽

Pierre Lasjaunias

Keyword(s):

Spinal Cord ◽

Adult Population ◽

Clinical Status ◽

Clinical Results ◽

Cervical Cord ◽

Karnofsky Performance Scale ◽

Presenting Symptoms ◽

Arteriovenous Shunts ◽

Thoracolumbar Region

Abstract OBJECTIVE: To review our series of intradural spinal cord arteriovenous fistulas (SCAVFs), analyzing symptoms and related angioarchitecture, and to study the morphological and clinical results of embolization. METHODS: Thirty-two SCAVFs (in 22 adults and 10 children) were treated between 1981 and 2000. These lesions were classified as microarteriovenous fistulas (mAVFs) or macroarteriovenous fistulas (MAVFs) according to shunt morphology. Location, architecture, presenting symptoms, and age group were detailed. The selection of patients for endovascular versus surgical treatments was analyzed, as were the anatomic and clinical results obtained by embolization with n-butylcyanoacrylate. Clinical status was evaluated according to the Karnofsky Performance Scale score. RESULTS: Ten SCAVFs were found in the pediatric population (four mAVFs and six MAVFs). All four mAVFs presented with acute symptoms. Three mAVFs (two cervical and one thoracic) presented hematomyelia; in one patient with a thoracic AVF, subarachnoid hemorrhage was suspected. All six MAVFs were located in the thoracolumbar cord (five associated with hereditary hemorrhagic telangiectasias). Four of the six MAVFs presented with hemorrhage. In the adult population, there were 21 mAVFS (95%) and one MAVF (5%). Only two mAVFs were found in the cervical cord, all other shunts affecting the thoracolumbar region. Hemorrhage was present in 6 of the 22 cases seen in adults (27%). The symptoms of SCAVFs did not differ from those found in spinal cord arteriovenous shunts of nidus type. Pial venous reflux and congestion were the most frequently encountered features in both the adult and pediatric groups. Arterial aneurysms (different from false aneurysms) were not found in association with hemorrhagic presentation of SCAVFs. Mean follow-up in our series was 3.3 years. Of the MAVFs, 86% were embolized, with 67% cured. The others had more than 75% occlusion. All patients followed up improved significantly. Of the mAVFs, 48% were treated endovascularly. Successful embolization was performed in 75% of patients. One patient was not embolized because of vasospasm, whereas 67% percent of mAVFs were completely occluded, 22% were more than 90% occluded, and 11% were 75% occluded. Complementary surgery was deemed unnecessary. All patients with mAVFs improved significantly at follow-up. Transient complications occurred in 22% of all patients, with no permanent morbidity or mortality. No patient bled or rebled after embolization. Thirty-six percent of mAVFs were operated on because of anticipated technical difficulties for endovascular approach or distal localization of the shunt. CONCLUSION: Endovascular treatment of SCAVFs stabilizes, normalizes, or improves neurological symptoms in all patients at long-term follow-up, with no bleeds or rebleeds. Embolization of SCAVFs with glue is a safe treatment that compares favorably with other approaches and significantly improves the poor natural history of the disease.

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Clinicopathological and imaging features of lipoastrocytoma: Case report

The Neuroradiology Journal ◽

10.1177/1971400917710667 ◽

2017 ◽

Vol 31 (1) ◽

pp. 32-38

Author(s):

Laxminadh Sivaraju ◽

Saritha Aryan ◽

Nandita Ghosal ◽

Alangar S Hegde

Keyword(s):

Spinal Cord ◽

Central Nervous System ◽

Nervous System ◽

Pediatric Population ◽

Pleomorphic Xanthoastrocytoma ◽

Imaging Features ◽

Total Excision ◽

Favorable Prognosis ◽

The Central Nervous System

Lipidized tumors of the central nervous system are very uncommon, with only a few cases described. We report a case of a 25-year-old woman with a tumor involving the left premotor area. She underwent gross total excision. Histologically, the tumor was composed of glial fibrillary acidic protein-positive glial cells with areas of lipidization. A diagnosis of lipoastrocytoma was rendered. At three-year follow-up she was doing well, supporting the presumed favorable prognosis of these uncommon tumors. Absence of xanthochromic appearance, mitotic activity, necrosis and poor reticulin activity are the differentiating features from the pleomorphic xanthoastrocytoma. We highlighted that these tumors involve the adult and pediatric population and distribute in both supratentorial and infratentorial compartments as well as in the spinal cord.

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The Natural History of Conservatively Managed Symptomatic Intramedullary Spinal Cord Cavernomas

Neurosurgery ◽

10.1227/01.neu.0000255437.36742.15 ◽

2007 ◽

Vol 60 (5) ◽

pp. 865-872 ◽

Cited By ~ 66

Author(s):

Siddharth Kharkar ◽

John Shuck ◽

James Conway ◽

Daniele Rigamonti

Keyword(s):

Spinal Cord ◽

Natural History ◽

Duration Of Symptoms ◽

Intramedullary Spinal Cord ◽

Additional Information ◽

History Of ◽

The Mean ◽

Spinal Cavernomas ◽

Time Of Presentation

Abstract OBJECTIVE The presentation and natural history of untreated, symptomatic intramedullary spinal cavernomas at our institution were analyzed. The objective is to provide additional information regarding the natural history of conservatively managed, symptomatic, intramedullary spinal cord cavernous malformations. METHODS The medical records of patients treated in our institution between 1989 and 2002 were reviewed to identify those with intramedullary cavernomas. The medical, radiological, surgical, and pathological records from these patients were retrospectively reviewed and analyzed. RESULTS Fourteen patients were included in the study. The mean age at presentation was 42 years. Four lesions (29%) were located in the cervical region and 10 lesions (71%) were present in the thoracolumbar spinal cord. All patients were symptomatic at the time of presentation. In this cohort of 14 patients, 10 patients (71%) were conservatively managed. For these patients, the mean duration of symptoms before presentation was 10 months. The mean duration of follow-up from the time of presentation was 80 months. The median McCormick grade for conservatively treated patients at presentation was II. During this period, none of the conservatively managed patients had an acute intramedullary bleed. In nine patients, the McCormick grade at the last follow-up evaluation was the same as or better than their score at presentation. Four patients (29%) were treated surgically. The mean duration of symptoms before presentation was 33 months. The mean duration of follow-up from the time of presentation was 42 months. In two surgical patients, the McCormick grade at the last follow-up evaluation remained unchanged compared with their score at presentation, whereas the McCormick grade improved in one patient and deteriorated in another patient. CONCLUSION This cohort of conservatively managed patients with symptomatic, intramedullary spinal cord cavernomas was clinically stable throughout the follow-up period. In this series, patients harboring symptomatic spinal cord cavernous malformation did not have significant, permanent neurological decline during the follow-up period when treated with the conservative approach of observation. This data provides additional information for determining the appropriate treatment strategy for patients with intramedullary spinal cavernomas.

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Spinal Cord Arteriovenous Malformations in a Pediatric Population Children below 15 Years of Age the Place of Endovascular Management

Interventional Neuroradiology ◽

10.1177/159101999500100106 ◽

1995 ◽

Vol 1 (1) ◽

pp. 29-42 ◽

Cited By ~ 29

Author(s):

G. Rodesch ◽

S. Pongpech ◽

H. Alvarez ◽

M. Zerah ◽

M. Hurth ◽

...

Keyword(s):

Spinal Cord ◽

Endovascular Treatment ◽

Arteriovenous Malformations ◽

Incidental Finding ◽

Pediatric Population ◽

Neurological Deficits ◽

Male Population ◽

Arteriovenous Shunts ◽

Weak Points ◽

Neurologically Normal

Among a global group of 164 spinal arteriovenous shunts, a series of 16 spinal cord arteriovenous malformations (SCAVMs) were diagnosed in a pediatric population below 15 years of age. The majority of the lesions affected the male population; 6 were located in the cervical spine and 10 at the thoracolumbar level. Hemorrhage was the most frequent symptom encountered (63%). Half of the bleeds occurred only in the subarachnoid spaces. Neurological deficits (acute or progressive) revealed the SCAVM in 31% of patients. The lesion was an incidental finding in one patient (6%). All the diagnoses (except one) were made by MRI. Selective angiography confirmed the diagnosis and identified the type of the lesion (nidus or fistula) and its angioarchitecture, stressing that the veins and their related features are the key point in the clinical eloquence of SCAVMs. All the treatments performed were endovascular; no patient was deemed a surgical candidate. Therapeutic abstention was decided in 37% of cases, mainly for anatomical reasons. All the patients in this group improved (50% being normal and 50% presenting slight non-handicapping deficits due to the initial accidents). Embolisation was indicated in 10 patients (63%) and was performed with fluid agents (histoacryl*) except in the first patient who had been treated with particles. Twelve percent of patients were cured (fistula), the remaining 88% having their lesion controlled to more than 50%. This partial treatment was always targetted towards the angioarchitectural weak points of the lesion. All patients improved after embolisation, 45% of them being neurologically normal. Follow-up in this group ranges from 1.5 to 13 Years. No complications occurred after embolisation. No bleed, rebleed or clinical worsening has occurred after endovascular treatment. The results in this series suggest that endovascular treatment (even partial but targetted) represents a safe and stable therapeutic alternative in the management of SCAVMs in this population.

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