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

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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Intradural spinal cord arteriovenous shunts in the pediatric population: natural history, endovascular management, and follow-up

Child s Nervous System ◽

10.1007/s00381-019-04108-0 ◽

2019 ◽

Vol 35 (6) ◽

pp. 945-955

Author(s):

Arturo Consoli ◽

Stanislas Smajda ◽

Johannes Trenkler ◽

Michael Söderman ◽

Georges Rodesch

Keyword(s):

Spinal Cord ◽

Natural History ◽

Pediatric Population ◽

Endovascular Management ◽

Arteriovenous Shunts

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Embolization of Spinal Cord Arteriovenous Shunts: Morphological and Clinical Follow-up and Results—Review of 69 Consecutive Cases

Neurosurgery ◽

10.1227/01.neu.0000068701.25600.a1 ◽

2003 ◽

Vol 53 (1) ◽

pp. 40-50 ◽

Cited By ~ 54

Author(s):

Georges Rodesch ◽

Michel Hurth ◽

Beatrice Ducot ◽

Hortensia Alvarez ◽

Philippe David ◽

...

Keyword(s):

Spinal Cord ◽

Endovascular Treatment ◽

Scale Score ◽

Karnofsky Performance Scale ◽

Arteriovenous Shunts ◽

The Mean ◽

Acrylic Glue ◽

Karnofsky Performance Scale Score ◽

Performance Scale

Abstract OBJECTIVE We sought to analyze the results of embolization in patients with intradural spinal cord arteriovenous shunts. METHODS The clinical and radiological files of 69 of a population of 155 patients treated with embolization between 1981 and 1999 were reviewed retrospectively. The patients' clinical status was evaluated according to Karnofsky Performance Scale score. Twenty-one (14%) of 155 patients were treated surgically because they were thought to be poor candidates for embolization. Twenty-four (15%) of 155 patients were considered untreatable with surgery or embolization; in these patients, follow-up was proposed, but only 8 of them were followed appropriately and remained stable after the first consultation. Forty-one (26%) of 155 patients consulted our group, but no follow-up could be obtained. In 69 (45%) of 155 patients, comprising 20 children and 49 adults, endovascular treatment was performed with the patients under general anesthesia and without provocative tests, mainly with acrylic glue, in 99% of these patients. RESULTS The mean number of diagnostic and therapeutic sessions was 3.5 per patient, and the mean number of pure therapeutic sessions was 1.5 per patient. Follow-up ranged between 6 months and 18 years (mean, 5.6 yr). In 16% of patients, anatomic obliteration of spinal cord arteriovenous shunts was obtained. Embolization reduced more than 50% of the spinal cord arteriovenous shunts in 86% of cases. No recanalization was noted on follow-up angiograms. Good clinical outcomes were obtained in 83% of the patients: 15% of them were asymptomatic, 43% were improved, and 25% were stable. In 4% of patients, embolization failed to stabilize the disease. Transient deficits were seen after embolization in 14% of the patients, and permanent severe complications occurred in 4% of the patients (Karnofsky Performance Scale score ≤70). Mild worsening was seen in 9% of the patients (Karnofsky Performance Scale score, 80). No bleeding or rebleeding was seen after endovascular treatment was considered to have been completed. CONCLUSION This study proves that embolization with acrylic glue is a therapeutic option that compares favorably with surgery or embolization with other agents (particles, coils, or balloons). It offers stable long-term clinical results, despite not necessarily achieving total cure. Studies of larger series with longer follow-up are necessary to confirm these encouraging therapeutic data.

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Natural history of spinal cord arteriovenous shunts: an observational study

Brain ◽

10.1093/brain/awz153 ◽

2019 ◽

Vol 142 (8) ◽

pp. 2265-2275 ◽

Cited By ~ 6

Author(s):

Jia-Xing Yu ◽

Tao Hong ◽

Timo Krings ◽

Chuan He ◽

Ming Ye ◽

...

Keyword(s):

Spinal Cord ◽

Natural History ◽

Spontaneous Recovery ◽

Clinical Course ◽

Early Period ◽

Acute Onset ◽

Clinical Deterioration ◽

Arteriovenous Shunts ◽

Initial Onset ◽

History Of

Abstract The natural history of intradural spinal cord arteriovenous shunts is unknown. We performed an observational study in a consecutive patient cohort with symptomatic intradural spinal cord arteriovenous shunts who were admitted to three institutes to investigate the clinical course of this complex disease, which would provide valuable evidence to inform clinical decision-making. The clinical course of patients with symptomatic intradural spinal cord arteriovenous shunts from initial presentation to occurrence of clinical deterioration, initiation of treatment, or last follow-up was analysed. Patients with at least 1 month of observation were included in this study. Clinical onset and deterioration patterns were divided into acute and gradual. Annual and cumulative rates of clinical deterioration as well as their risk factors were analysed using Kaplan-Meier life table analysis and Cox proportional hazards model. To assess risks and benefits of treatment, post-treatment clinical courses were further assessed. Four hundred and sixty-six patients with a mean observational period of 36.9 ± 58.8 months were included; 56.7% of patients presented with acute onset, of whom 77.3% experienced spontaneous recovery. Age of onset older than 28 years, initial modified Aminoff and Logue scale of >3, mid-thoracic lesions and non-ventral lesions were independent predictors of failure for spontaneous recovery. The annual risk of general, acute and gradual clinical deterioration after onset was 30.7%, 9.9% and 17.7%, respectively. Risk of deterioration was highest in the early period after initial onset. Acute onset was the only independent risk factor [hazard ratio 1.957 (95% confidence interval, CI 1.324–2.894); P = 0.0008] of acute deterioration and gradual onset was the strongest predictor [hazard ratio 2.350 (95% CI 1.711–3.229); P < 0.0001] of the gradual deterioration among all the stratifying factors. After invasive treatment, complete obliteration was achieved in 37.9% of patients (138 of 364) and improved or stable clinical status was noted in 80.8% of patients. Forty-two patients (11.5%) experienced permanent complications. Overall post-treatment deterioration rate was 8.4%/year, and 5.3%/year if permanent complications were excluded. The natural history of symptomatic spinal cord arteriovenous shunts is poor, especially in the early period after onset, and early intervention is thus recommended. Initial onset pattern significantly affects the natural history of the lesion, which prompts a differentiated treatment strategy.

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

Child s Nervous System ◽

10.1007/s00381-019-04249-2 ◽

2019 ◽

Vol 35 (8) ◽

pp. 1281-1281

Author(s):

Arturo Consoli ◽

Stanislas Smajda ◽

Johannes Trenkler ◽

Michael Söderman ◽

Georges Rodesch

Keyword(s):

Spinal Cord ◽

Natural History ◽

Pediatric Population ◽

Endovascular Management ◽

Arteriovenous Shunts

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Emergency endovascular treatment for ruptured abdominal aortic aneurysm and the risk of spinal cord ischemia

Journal of Vascular Surgery ◽

10.1016/j.jvs.2005.06.023 ◽

2005 ◽

Vol 42 (4) ◽

pp. 608-614 ◽

Cited By ~ 52

Author(s):

Noud Peppelenbosch ◽

Philippe W.M. Cuypers ◽

Anco C. Vahl ◽

Frank Vermassen ◽

Jacob Buth

Keyword(s):

Spinal Cord ◽

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Endovascular Treatment ◽

Spinal Cord Ischemia ◽

Ruptured Abdominal Aortic Aneurysm ◽

Abdominal Aortic

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Prediction of spinal cord ischemia with a retrievable stent graft on endovascular treatment for a case of thoracic aortic aneurysm

The Japanese Journal of Thoracic and Cardiovascular Surgery ◽

10.1007/bf03217872 ◽

1998 ◽

Vol 46 (10) ◽

pp. 1047-1051 ◽

Cited By ~ 7

Author(s):

Satoshi Kawaguchi ◽

Shin Ishimaru ◽

Nobusato Koizumi ◽

Taro Shimazaki ◽

Yukio Obitsu ◽

...

Keyword(s):

Spinal Cord ◽

Aortic Aneurysm ◽

Endovascular Treatment ◽

Stent Graft ◽

Thoracic Aortic Aneurysm ◽

Spinal Cord Ischemia ◽

Retrievable Stent

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Re-activation of varicella zoster virus associated with anterior spinal cord stroke in pregnancy

Infectious Diseases ◽

10.1080/23744235.2016.1185535 ◽

2016 ◽

Vol 48 (9) ◽

pp. 705-707 ◽

Cited By ~ 3

Author(s):

John F. McNamara ◽

David L. Paterson ◽

Anthony Allworth ◽

Jeffrey Presneill ◽

Paul O’Connell ◽

...

Keyword(s):

Spinal Cord ◽

Varicella Zoster Virus ◽

Varicella Zoster ◽

In Pregnancy

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Cervical Perimedullary Arteriovenous Shunts

Neurosurgery ◽

10.1227/neu.0000000000000401 ◽

2014 ◽

Vol 75 (3) ◽

pp. 238-249 ◽

Cited By ~ 14

Author(s):

Toshiki Endo ◽

Hiroaki Shimizu ◽

Kenichi Sato ◽

Kuniyasu Niizuma ◽

Ryushi Kondo ◽

...

Keyword(s):

Spinal Cord ◽

Anterior Approach ◽

Open Surgery ◽

Treatment Strategies ◽

Good Recovery ◽

Intraoperative Angiography ◽

Indocyanine Green Videoangiography ◽

Arteriovenous Shunts ◽

Complete Obliteration

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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The natural history of transdural herniation of the spinal cord: case report

Neuroradiology ◽

10.1007/s002340000469 ◽

2001 ◽

Vol 43 (5) ◽

pp. 383-387 ◽

Cited By ~ 27

Author(s):

R. F. Adams ◽

P. Anslow

Keyword(s):

Spinal Cord ◽

Case Report ◽

Natural History ◽

History Of

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