Differential angiographic features f hemangioblastomas and arteriovenous malformations of the spinal cord.

Abstract

REMOVAL of spinal cord hemangioblastomas (angioreticulomas) can be successfully accomplished (10, 17). Surgery of arteriovenous malformations of the spinal cord has given satisfactory results also (9). The operative approach to these two types of lesions is, however, quite different—myelotomy in cases of hemangioblastomas (10, 17) versus ablation of the pathological vessels (13, 19, 20) or ligation of the feeders (16) in th e arteriovenous malformations. Recently, percutaneous embolization has been tried with success in the vascular malformations (8, 15). Obviously, therefore, a correct differential diagnosis between these two types of lesions is of practical importance. This distinction, however, is not an easy oneeither at myelography or even at surgery (14). According to Kendall and Russell (11) and to Paillas et at. (17) hemangioblastomas of the cord can be recognized at positive contrast myelography on the basis of a combination of expansion of the spinal cord shadow and worm-like defects suggesting dilated surface vessels. In our experience, also, hemangioblastomas of the spinal cord have indeed shown the combination of expanded cord and serpiginous defects (Fig. 1). These findings, however, may also be encountered in tumors of the glioma group (Fig. 2). More important because of the difference in therapeutic approach is that arteriovenous malformations may present the same radiographic changes. This has been true in several of our cases (Figs. 3 and 4) . Diagnostic methods other than myelography have to be considered, therefore, to distinguish between th e two types of lesions, and angiogra phy seems to be the logical answer to this problem. Arteriographic examination of spinal cord arteriovenous malformations (6) especially with th e selective technic (2, 5) is well established. On the other hand, very few cases of an giographic studies of spinal hemangioblastomas are to be found in the literature. Arteriographic examination of spinal cord arteriovenous malformations (6) especially with th e selective technic (2, 5) is well established. On the other hand, very few cases of an giographic studies of spinal hemangioblastomas are to be found in the literature. Tarlov (22) in 1947 reported a case of spinal hemangioblastoma studied by angiography performed during surgery; this was, however, an extradural lesion. The first case involving the cord was reported by Di Chiro (1) in 1957; it was localized in the cervical segment and was associated with similar cerebellar lesions . Angiography was carried out by direct needle vertebral puncture. A second case by Guidetti and Fortuna (10) involved the upper cervical cord and extended into the medulla oblongata. Dilenge and David (3) have also reported a case of cervical cord hemangioblastomas encountered as an incidental finding during vertebral arteriography for evaluation of similar cerebellar lesions.