Introduction/Purpose Retrospective study of spinal angiography and management of spinal arterio-venous malformations, at the department of Neuroradiology, Neurosciences Center, All India Institute of Medical Sciences, New Delhi, India, between 1989 and June 2011.
Materials and Methods 190 patients were analyzed. 17 were negative angiograms. Four had spinal tumors. Arterio-venous spinal malformation was diagnosed in 169 patients.
Results Among these 169 patients, 51 (30.2%) had spinal dural arteriovenous fistulae (SDAVFs), 48 (28.4%) had spinal cord arteriovenous malformations (SCAVMs), 58 (34.3%) had spinal cord arteriovenous fistulae (SCAVFs), 9 (5.3%) had epidural arteriovenous fistulae and 3 (1.8%) miscellaneous lesions. Overall preponderance of males (75%) was observed. SCAVF was the most common vascular lesion in our series. 90% of SDAVF patients were male. Most had progressive symptoms of motor weakness (96%), sensory deficits (90%) and sphincter disturbances (88%). Dorso-lumbar (D6–L2) location common, except one fistula at foramen magnum. In four patients, there were two fistulae each, two of them metachronous and two of them synchronous. Mean time to diagnosis in SDAVF was 12.9 months. 34 SDAVF patients were treated by surgery which improved or stabilized the clinical status in 88.5% & 3 (11.5%) deteriorated after surgery. Embolization was successful in 58% patients attempted & all improved with no recurrence. SCAVFs (58) outnumbered SCAVMs (48). Macro SCAVFs were preferentially treated by embolization and all except one improved. 60% Micro-AVFs treated by embolization and 93% of them improved. On the other hand 33% Micro-AVFs worsened after surgery. Three out of seven radicular fistulae treated by embolization improved clinically. Surgery was preferred for filar fistulae and 90% improved. Mean age of presentation for SCAVM was 25 years and 31.25% of them were younger than 20 years. 33% had acute however MR evidence of haematomyelia was seen in only 10%. 75% were Glomus type, 16.5% Multimyelomeric and four (8.5%) had Metameric malformations. 56% focal cord lesions occurred in dorso-lumbar region. Conus AVMs were between 21 and 30 years. Three out of four metameric lesions involved cervical segments. Venous ectasia, pial venous reflux and arteriovenous micro-fistulae were dominant angiographic features in SCAVMs. Aneurysm or pseudo-aneurysms were observed in 31.25% of cases. Out of 35 SCAVMs, 29 (83%) were treated by embolization with improvement or stabilization in 86%. 90% or more nidus obliteration could be achieved in 13 (44.83%), 80-90% in 7 (24.14%), 60-80% in 5 (17.24%) and 40%–60% in 4 (13.79%). Surgery improved or stabilized five out of six SCAVMs and one deteriorated. Six epidural AVMs and three vertebra-venous (VVF) fistulae were treated by embolization with cure of VVFs. Epidural AVMs typically required multiple sessions. Two spinal artery aneurysms in collateralized spinal artery were treated by coiling.
Conclusion Endovascular treatment is effective in treating majority of spinal vascular lesions. Surgery can be reserved for selective situations like filar AVFs, lesions with unfavorable for endovascular embolizations and failed embolizations.
Competing interests None.