[Diagnostic work-up and therapy of spinal vascular malformations: an update].

INTRODUCTION: Spinal vascular malformations are rare disease patterns with a clinical incidence of about 5-10/year/1 million comprising spinal arteriovenous malformations (sAVM), spinal arteriovenous fistulas (sAVF) and spinal cavernomas. Long courses of disease before diagnosis deteriorate the prognosis despite successful treatment.
METHODS: Selective review of the literature in consideration of present guidelines.
RESULTS: Spinal vascular pathological conditions can be classified into different subtypes especially by use of magnetic resonance imaging (MRI) and selective digital subtraction angiography (DSA). Diagnosis and treatment of spinal dural arteriovenous fistula (type I) as well as spinal arteriovenous malformations (type II-V) ideally require a close co-operation between neurosurgeons and neuroradiologists. Surgery can in general be considered as curative. Endovascular therapy of arteriovenous malformations results in reduction of size and concomitant haemodynamic effects. A curative approach is generally not possible. Particularly in cases of lumbosacral and craniosacral arteriovenous fistulas the interventional procedure provides advantages. Treatment of spinal cavernomas nowadays consists of neurosurgical approaches exclusively. The significance of radiosurgical therapy, especially with the CyberKnife, remains indistinct. Today, interdisciplinary neurosurgical and neuroradiological co-operation in specialized centres allows most spinal vascular malformations to be diagnosed at an early stage and to be treated with satisfying results.