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Case series
Endovascular management of aneurysms associated with spinal arteriovenous malformations
  1. Sung Chul Jung1,
  2. Yunsun Song1,
  3. Su Hee Cho1,
  4. Joonggoo Kim1,
  5. Seung Yeon Noh1,
  6. Sang Hun Lee1,
  7. Jae Jon Sheen1,
  8. Seung Chul Rhim2,
  9. Sang Ryong Jeon2,
  10. Dae Chul Suh1
  1. 1Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
  2. 2Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
  1. Correspondence to Dr Dae Chul Suh, Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Korea; dcsuh{at}amc.seoul.kr

Abstract

Background Spinal aneurysms are rare among spinal arteriovenous malformations (SAVMs). There are few reports of endovascular management of spinal aneurysms associated with SAVM.

Objective To present endovascular management of aneurysms associated with SAVM.

Methods Of 91 patients with SAVMs,eight (9%) presented with aneurysms. Of these, three were male and five were female with a median age of 18 years (range 11–38). We evaluated the presenting pattern, lesion level, type of the target aneurysm related to the presenting pattern and AVM nidus, and the result obtained after embolization or open surgery. Clinical status was evaluated by Aminoff–Logue (ALS) gait and micturition scale scores.

Results The presenting patterns were subarachnoid hemorrhage (SAH, n=3) or mass effect caused by extrinsic (n=4) or intrinsic (n=1) cord compression. Aneurysms were located in four cervical, two thoracic, and two lumbar enlargement areas. There were two prenidal (arterial), three nidal, and three postnidal (venous) aneurysms. The mean diameter of the aneurysms was 9 mm (range 3–27). Glue embolization (n=6), open surgery (n=1), and combined surgery and embolization (n=1) was performed to obliterate the aneurysms. Obliteration of the target aneurysms resulted in improvement of symptoms and clinical stabilization of SAVMs in all patients during a mean of 55 months (range 7–228) of follow-up.

Conclusions Identification of a symptomatic aneurysm should be associated with clinical presentation pattern. Targeted obliteration of the aneurysm by embolization and/or surgery resulted in improvement of symptoms and stabilization of SAVM.

  • spine
  • arteriovenous Malformation
  • aneurysm
  • embolic

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Footnotes

  • Contributors SCJ: main idea development, manuscript writing; YS: manuscript preparation, data collection, literature review, manuscript revision; JK: literature review; SHC: data analysis, literature review; SYN: data collection, literature review; SHL , JJS: literature review; SCR, SRJ: study development, DCS: main idea development, manuscript writing and editing, study development.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval Institutional review board of the Asan Medical Center.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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