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Abstract
Introduction Complete obliteration of spinal cord AVM-s without neurological deficit is rarely achieved either by surgery or embolization. Liquid embolics carry high risk, while particles have low efficacy. Application of selected size embolic beads capable of penetrating the nidus but not entering the sulco-comissural arteries has been proposed but not largely reported in the literature. We present two such cases
Case Description A 16 year old girl suffering from progressive spastic paraparesis and hypaestesia resulting from a Th.IX-X. intramedullary AVM was treated with 3-500 and 7-900 mikron BeadBlockTM (Biocompatibles Ltd.) embolic beads injected from the proximal radicular artery. A high flow shunt was closed by NBCA embolization. Approximately 2/3 of the AVM nidus was occluded on the final angiograms. After temporary progression on day 1 she rapidly improved and was able to walk and run without any assistance 6 weeks later.
Case 2 was a 47 year old women, who was surgically treated for a C.II. intramedullary AVM in 1995. She started having progressive weakness of he left extremities in 2021 and MRI in 2023 demonstrated a residual spinal cord AVM at the C.II. level. This was embolized with 7-900 mikron BeadBlockTM beads injected from the proximal radicular artery at C.V. After temporary progression, she rapidly improved and within 6 weeks she returned to her original status prior to her neurological progression in 2021.
Results We concluded that using selected size embolic beads from proximal locations is a safe and on the short term highly effective mode of treatment for spinal cord AVM-s.
