DIAGNOSIS AND EMBOLIZING OF SPINAL ARTERIOVENOUS-MALFORMATIONS

Spinal arteriovenous malformations are uncommon disorders associated w ith considerable difficulty in diagnosis and treatment. They are divid ed into dural arteriovenous fistulas and intradural medullary spinal c ord angiomas. In this retrospective series of six patients the clinica l outcome of embolization is presented. The patient material consisted of three dural fistulas and three cord angiomas, one of which bled ca using sudden paresis, pain and incontinence. In the remaining five pat ients the symptoms were progressive consisting of paraesthaesias, para paresis, pain and incontinence. The clinical status of four patients w as not changed after the treatment, one deterioriated and one improved . There were no bleedings after the therapy. In one patient spinal ang iography for follow-up was performed and recanalization was seen in th e dural fistula after particle embolization. Also, in one cord angioma embolized with particles reflow appeared in the immediately repeated angiography. For permanent angioma occlusion tissue adhesive is prefer red as embolic material. Surgical therapy as an alternative or adjuvan t to embolization is discussed with a review of the literature. Early timing of the therapeutic intervention is stressed to avoid the develo pment of irreversible ischaemic medullopathy and to prevent haemorrhag e. The therapeutic procedures at the early stage of the disease may be curable or, at least, halt the progression of the symptoms, Cross-sec tional imaging studies and myelographies may reveal the lesion. For th e definitive diagnosis of spinal angioma with its vascular feeders and for the evaluation of its occlusion grade after the therapy selective spinal angiography is needed.