Vascular lesions of the spinal cord

2019 ◽  
pp. 751-760
Author(s):  
Daniel Walsh
Keyword(s):  
Spinal Cord ◽  
Vascular Malformations ◽  
Current Approach ◽  
Vascular Lesions ◽  
Neoplastic Processes ◽  
Management Challenge ◽  
Spinal Malformations

Vascular malformations of the spinal cord are uncommon and diverse conditions. Presentation is frequently with an indolent, radiculomyelopathy, the origins of which will be traced back many months or years. Fruitless investigation may be pursued for inflammatory or neoplastic processes. This is all the more regrettable as many such malformations are treatable. Haemorrhage from spinal malformations is still more rare and a considerable management challenge. In this chapter we will describe the pathophysiology of these conditions and summarize the current approach to management, while the adaptation of the Bicêtre system is covered towards the end. The pathophysiology of spinal ischaemia and primary spinal haemorrhage is also reviewed.

scholarly journals Introduction: Spinal Vascular Malformations

2009 ◽  
Vol 26 (1) ◽  
pp. E1 ◽  
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.

scholarly journals Multifocal and Metameric Spinal Cord Arteriovenous Malformations

1999 ◽  
Vol 5 (1) ◽  
pp. 27-34 ◽  
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.

Modified classification of spinal cord vascular lesions

2002 ◽  
Vol 96 (2) ◽  
pp. 145-156 ◽  
Author(s):  
Robert F. Spetzler ◽  
Paul W. Detwiler ◽  
Howard A. Riina ◽  
Randall W. Porter
Keyword(s):  
Spinal Cord ◽  
Classification System ◽  
Arteriovenous Malformations ◽  
Vascular Malformations ◽  
Relevant Literature ◽  
Vascular Lesions ◽  
Cavernous Malformations ◽  
Content Type ◽  
Arteriovenous Fistulas ◽  
Fine Print

The literature on spinal vascular malformations contains a great deal of confusing terminology. Some of the nomenclature is inconsistent with the lesions described. Based on the experience of the senior author (R.F.S.) in the treatment of more than 130 spinal cord vascular lesions and based on a thorough review of the relevant literature, the authors propose a modified classification system for spinal cord vascular lesions. Lesions are divided into three primary or broad categories: neoplasms, aneurysms, and arteriovenous lesions. Neoplastic vascular lesions include hemangioblastomas and cavernous malformations, both of which occur sporadically and familially. The second category consists of spinal aneurysms, which are rare. The third category, spinal cord arteriovenous lesions, is divided into arteriovenous fistulas and arteriovenous malformations (AVMs). Arteriovenous fistulas are subdivided into those that are extradural and those that are intradural, with intradural lesions categorized as either dorsal or ventral. Arteriovenous malformations are subdivided into extradural-intradural and intradural malformations. Intradural lesions are further divided into intramedullary, intramedullary-extramedullary, and conus medullaris, a new category of AVM. This modified classification system for vascular lesions of the spinal cord, based on pathophysiology, neuroimaging features, intraoperative observations, and neuroanatomy, offers several advantages. First, it includes all surgical vascular lesions that affect the spinal cord. Second, it guides treatment by classifying lesions based on location and pathophysiology. Finally, it eliminates the confusion produced by the multitude of unrelated nomenclatural terms found in the literature.

scholarly journals 3D DCE-MRA in spinal vascular malformations

2021 ◽  
Author(s):  
Jibin Cao ◽  
Sijia Gao ◽  
Wenge Sun ◽  
Lingling Cui
Keyword(s):  
Spinal Cord ◽  
Surgical Treatment ◽  
Clinical Symptoms ◽  
Vascular Malformations ◽  
High Sensitivity ◽  
Vascular Lesions ◽  
Arterial Blood Supply ◽  
3 Dimensional ◽  
Spinal Vascular Malformations ◽  
Arterial Blood

Abstract Purpose: This study was carried out to investigate whether 3.0T dynamic enhanced 3 dimensional magnetic resonance angiography (3D DCE-MRA) could identify spinal cord vascular malformations efficiently.Material and Methods: 32 suspected cases of spinal vascular disease with MR imaging and clinical symptoms were detected using DCE-MRA. 28 patients were valued through DSA for 3-5 days, and surgical treatment was performed on 24 patients. Results: DCE-MRA was used to examine all the cases which recognized abnormal vascular lesions clearly, and 28 cases were consistent with DSA or surgical diagnosis. The arterial blood supply was evaluated accurately in 28 cases. The findings were correct in 26 cases.Conclusion: 3.0T DCE-MRA features high sensitivity and accuracy in detecting and characterizing SVMs, especially SDAVF.

scholarly journals Intramedullary Cavernoma: Case Report and Literature Review

2019 ◽  
Vol 2 (1) ◽  
Keyword(s):  
Spinal Cord ◽  
Vascular Malformations ◽  
Cord Compression ◽  
Lower Limbs ◽  
Low Flow ◽  
Vascular Lesions ◽  
Spinal Vascular Malformations ◽  
Patient Reported ◽  
Spinal Cord Compression Syndrome ◽  
Chronic Myelopathy

Introduction: Cavernomas are benign vascular anomalies consisting of cavities where the blood circulates at low flow and at low pressure. Intramedullary localization is unusual, represents approximately 5 to 12% of spinal vascular malformations and 3% of intra-dural vascular malformations (5% of medullary vascular lesions). Observation: A patient, aged 59, consulted for the abrupt installation of moderate back pain followed by predominant muscle weakness in the two lower limb of progressive worsening, responsible for gait disorders. The patient reported thermal hypoesthesia and heaviness of the two lower limbs that had been evolving for two years. The examination found a dorsal spinal cord compression syndrome. On the MRI, there were abnormalities of intramedullary signal of the dorsal (D11) spinal cord with bleeding stigmas suggestive of intramedullary cavernomas. Conclusion: The management of the medullary cavernoma is essentially neurosurgical with complete microsurgical resection of the malformation. In the absence of surgical treatment, evolution can be to chronic myelopathy or neurological aggravation.

Surgical resection of intramedullary spinal cord cavernous malformations

1993 ◽  
Vol 78 (3) ◽  
pp. 446-451 ◽  
Author(s):  
John A. Anson ◽  
Robert F. Spetzler
Keyword(s):  
Spinal Cord ◽  
Surgical Resection ◽  
Vascular Malformations ◽  
Surgical Excision ◽  
Vascular Lesions ◽  
Complete Relief ◽  
Intramedullary Spinal Cord ◽  
Cavernous Malformations ◽  
Excellent Outcome ◽  
Complete Surgical Excision

✓ Cavernous malformations are being increasingly well recognized throughout the central nervous system, where they compose approximately 1% of all vascular lesions and 15% of all vascular malformations. These malformations are uncommon in the spinal column and rarely found within the spinal cord. There have been only a few isolated reports of surgical resection of intramedullary spinal cord cavernous malformations. A series of six patients with intramedullary spinal cord cavernous malformations is described; all were treated by complete surgical excision, and all had a good or excellent outcome with partial or complete relief of neurological symptoms. There were no surgical complications, although transient postoperative neurological worsening was common. The clinical, radiological, and surgical features of these patients are discussed. It is concluded that intramedullary spinal cord cavernous malformations are an uncommon cause of progressive myelopathy that can be safely and effectively treated by surgical excision.

scholarly journals Intramedullary Cavernoma: Case Report and Literature Review

2019 ◽  
Vol 2 (1) ◽  
Keyword(s):  
Spinal Cord ◽  
Vascular Malformations ◽  
Cord Compression ◽  
Lower Limbs ◽  
Low Flow ◽  
Vascular Lesions ◽  
Spinal Vascular Malformations ◽  
Patient Reported ◽  
Spinal Cord Compression Syndrome ◽  
Chronic Myelopathy

Introduction: Cavernomas are benign vascular anomalies consisting of cavities where the blood circulates at low flow and at low pressure. Intramedullary localization is unusual, represents approximately 5 to 12% of spinal vascular malformations and 3% of intra-dural vascular malformations (5% of medullary vascular lesions). Observation: A patient, aged 59, consulted for the abrupt installation of moderate back pain followed by predominant muscle weakness in the two lower limb of progressive worsening, responsible for gait disorders. The patient reported thermal hypoesthesia and heaviness of the two lower limbs that had been evolving for two years. The examination found a dorsal spinal cord compression syndrome. On the MRI, there were abnormalities of intramedullary signal of the dorsal (D11) spinal cord with bleeding stigmas suggestive of intramedullary cavernomas. Conclusion: The management of the medullary cavernoma is essentially neurosurgical with complete microsurgical resection of the malformation. In the absence of surgical treatment, evolution can be to chronic myelopathy or neurological aggravation.

scholarly journals CT angiography and MRI of hand vascular lesions: technical considerations and spectrum of imaging findings

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Alain G. Blum ◽  
Romain Gillet ◽  
Lionel Athlani ◽  
Alexandre Prestat ◽  
Stéphane Zuily ◽  
...  
Keyword(s):  
Doppler Ultrasonography ◽  
Spindle Cell ◽  
State Of The Art ◽  
Vascular Malformations ◽  
Vascular Lesions ◽  
Systemic Diseases ◽  
Contrast Enhanced ◽  
Vascular Compromise ◽  
Exposure To Trauma ◽  
Technical Considerations

AbstractVascular lesions of the hand are common and are distinct from vascular lesions elsewhere because of the terminal vascular network in this region, the frequent hand exposure to trauma and microtrauma, and the superficial location of the lesions. Vascular lesions in the hand may be secondary to local pathology, a proximal source of emboli, or systemic diseases with vascular compromise. In most cases, ischaemic conditions are investigated with Doppler ultrasonography. However, computed tomography angiography (CTA) or dynamic contrast-enhanced magnetic resonance angiography (MRA) is often necessary for treatment planning. MR imaging is frequently performed with MRA to distinguish between vascular malformations, vascular tumours, and perivascular tumours. Some vascular tumours preferentially affect the hand, such as pyogenic granulomas or spindle cell haemangiomas associated with Maffucci syndrome. Glomus tumours are the most frequent perivascular tumours of the hand. The purpose of this article is to describe the state-of-the-art acquisition protocols and illustrate the different patterns of vascular lesions and perivascular tumours of the hand.

Treatment options and long-term outcomes in pediatric spinal cord vascular malformations: a case report and review of the literature

2020 ◽  
Vol 36 (12) ◽  
pp. 3147-3152
Author(s):  
Helen J. Zhang ◽  
Nicole Silva ◽  
Elena Solli ◽  
Amanda C. Ayala ◽  
Luke Tomycz ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Case Report ◽  
Vascular Malformations ◽  
Treatment Options ◽  
Review Of The Literature ◽  
Long Term Outcomes

Spinal cord arteriovenous malformation with an associated lymphatic anomaly

1990 ◽  
Vol 73 (5) ◽  
pp. 768-773 ◽  
Author(s):  
Gary E. Kraus ◽  
Richard D. Bucholz ◽  
Thomas R. Weber
Keyword(s):  
Spinal Cord ◽  
Lymphatic System ◽  
Vascular Lesions ◽  
Dietary Manipulation ◽  
Paravertebral Muscle ◽  
Content Type ◽  
Muscle Fascia ◽  
Spinal Osteomyelitis ◽  
The Central Nervous System ◽  
Spinal Cord Arteriovenous Malformation

✓ Spinal cord arteriovenous malformations (AVM's), like other vascular anomalies of the central nervous system, can be associated with similar vascular lesions of the skin and viscera. A 7-year-old girl, who presented with rapidly progressing paraplegia, was found to have a spinal cord AVM, cutaneous angioma, and a chylous malformation of the lymphatic system. She had previously undergone treatment for a posterior thoracic cutaneous angioma. At surgery, upon incision of the paravertebral muscle fascia, viscous pale fluid was encountered emanating from a foramen in the thoracic lamina. The spinal AVM was resected in spite of concern that the abnormality represented spinal osteomyelitis. Postoperatively, there was full return of function in the lower extremities, along with recurrent episodes of chylothorax, which slowly came under control with dietary manipulation. A review of the anatomy of the thoracic duct and nontraumatic causes of chylothorax is presented, and the association of cutaneous and central angiomas is discussed. Finally, the treatment of chylothorax is delineated.

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