CLASSIFICATION AND THERAPEUTIC MODALITIES OF SPINAL VASCULAR MALFORMATIONS IN 80 PATIENTS

OBJECTIVE: To set up a more detailed classification system for spinal vascular malformations and to discuss the relationship between the cla ssification and therapeutic alternatives. METHODS: Case series from th e tertiary care center were studied. Spinal vascular malformations in 80 patients were reviewed and classified into intramedullary arteriove nous malformations (AVMs) (juvenile and glomus AVMs), intradural arter iovenous fistulas (AVFs) (Types I-III), dural AVFs, paravertebral AVMs , and Cobb's syndrome. Therapeutic alternatives to each type of spinal vascular malformations, including surgery, endovascular embolization, and a combination of both, as well as the short-term outcomes, were a nalyzed. RESULTS: Of the 80 patients, 38 (47.5%) had intramedullary AV Ms (23 juvenile and 15 glomus AVMs), 27 (33.8%) had intradural AVFs (6 Type I, 14 Type II, and 7 Type III), 8 (10%) had dural AVFs, and 7 (8 .8%) had other malformations. Most of the juvenile AVMs and the Types II and III AVFs were treated by endovascular embolization. Other lesio ns were treated by surgery or preoperative embolization plus surgery. Among the 76 patients whom we treated, early clinical improvement was achieved in 66 (86.8%). Six (7.9%) remained stable, and four (5.3%) be came worse. CONCLUSION: Our classification system offers only limited guidance for the treatment of spinal vascular malformations. Successfu l treatment in each individual spinal vascular malformation requires c orrect understanding of the lesion's anatomic location and its angioar chitecture, as well as the limitations of both surgery and endovascula r embolization.