Comprehensive Management of Arteriovenous Malformations of the Brain and Spine by

Language: eng
Format: azw3
Publisher: Cambridge University Press
Published: 2014-12-30T16:00:00+00:00

Chapter 14 Surgery of spinal arteriovenous malformations and fistulae

M. Yashar, S. Kalani, George A. C. Mendes, Maziyar A. Kalani and Robert F. Spetzler

Comprehensive Management of Arteriovenous Malformations of the Brain and Spine, ed. Robert F. Spetzler, Douglas S. Kondziolka, Randall T. Higashida, and M. Yashar S. Kalani. Published by Cambridge University Press. © Cambridge University Press 2015.

Introduction

The first reports of a spinal vascular malformations were by Hebold [1] and Gaupp [2] in the 1880s. These were followed by the first successful surgical treatment of a spinal malformations (a fistula) by Krause in 1911 [3] and the first major series by Wyburn-Mason in 1943 [4]. With the introduction and widespread use of spinal angiography, these lesions have become more frequently identified and treated. Aminoff and Logue are credited with the first systematic review of the presentation and natural history of spinal malformations, which they reported in 1974 [5]. They proposed that abnormal shunting and the resultant venous congestion were responsible for the decreased intramedullary blood flow and the symptoms noted in most patients. This mechanistic observation was further refined to the current theory of venous congestion as the etiology behind these lesions. Indeed, the treatment strategies for spinal vascular malformations are based on this mechanistic understanding of venous congestion inciting neurological decline.

Spinal arteriovenous fistulae (AVFs) and spinal arteriovenous malformations (AVMs) have distinct characteristics with respect to incidence, sex predominance, age at onset of symptoms, etiology, pathophysiology, location along the spinal axis, clinical presentation, and natural history [6]. The current therapies for these lesions, including endovascular and microsurgical treatments, depend on disconnecting the shunt and decreasing venous congestion. This chapter focuses on the microsurgical treatment of spinal AVFs and AVMs. In many cases, treatment of spinal vascular malformations requires a multidisciplinary approach with surgeons, interventionalists, and radiation therapists working side by side to provide optimal holistic care for the patient.

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