Spinal cord vascular diseases

Abstract

Spinal vascular malformations include various entities, including spinal dural arteriovenous (AV) fistulas, acquired malformations and cavernous hemangiomas, and spinal arteriovenous malformations. AV fistula refers to aspinal cord vascular malformation in which there is a short-circuit connection between adural artery and aperimedullary vein superficial to the myelon. The condition is relatively rare, initial clinical symptoms are often misinterpreted, and adefinitive diagnosis is often delayed by 12months or more. However, early diagnosis is important to prevent progression of clinical symptoms, which may include paraplegia. Early magnetic resonance imaging (MRI) is helpful, showing intramedullary edema in the T2-weighted sequences and superficial, markedly dilated veins. Treatment consists of ligation of the AV fistula, either surgically or by embolization. Cavernous hemangiomas, consisting of alarge number of closely located immature blood vessels, are also relatively rare and have alow risk of bleeding (approximately 0.2-0.5%). Venous hemorrhage may also occur, resulting in clinical symptoms (including paraplegia).