Young-Jun Lee1, Karel G Terbrugge1, Guillaume Saliou1, Timo Krings2. 1. From the Department of Medical Imaging (Y.-J.L., K.G.T., G.S., T.K.), and Division of Neurosurgery (T.K.), Toronto Western Hospital, University of Toronto, Ontario, Canada; Department of Radiology, Hanyang University Hospital, Hanyang University College of Medicine, Seoul, Korea (Y.-J.L.); and Service de Neuroradiologie, CHU Bicêtre, Le Kremlin Bicêtre Cedex, France (G.S.). 2. From the Department of Medical Imaging (Y.-J.L., K.G.T., G.S., T.K.), and Division of Neurosurgery (T.K.), Toronto Western Hospital, University of Toronto, Ontario, Canada; Department of Radiology, Hanyang University Hospital, Hanyang University College of Medicine, Seoul, Korea (Y.-J.L.); and Service de Neuroradiologie, CHU Bicêtre, Le Kremlin Bicêtre Cedex, France (G.S.). Timo.Krings@uhn.ca.
Abstract
BACKGROUND AND PURPOSE: As a result of the rarity of spinal cord arteriovenous malformations (AVM), there are only a few series available that describe clinical features, outcome after treatment, and natural history of these lesions. In this article, we aim to describe our experience with both nidus- and fistulous-type spinal cord AVMs. METHODS: Forty-four consecutive patients with spinal cord AVMs were retrospectively reviewed. There were 26 patients with a nidus-type and 18 patients with a fistulous-type AVM. Treatments were performed with embolization (n=23), surgery (n=13), combined embolization-surgery (n=3), or conservative management (n=5). Clinical features, radiological findings, treatment results, and clinical outcomes were assessed. RESULTS: Patients with nidus-type AVMs were younger at presentation and more often presented with hemorrhage, with a higher proportion of hematomyelia than fistulous-type AVMs (P<0.05). Progression of clinical presentation from hemorrhage to congestive myelopathy during follow-up was noted in 5 patients, all of which had AVMs of the nidus type. Complete obliteration could be achieved more often in the fistulous type (72%) than in the nidus type (27%). Improved or stable clinical status at last follow-up was noted in 100% of fistulous-type and 77% of nidus-type patients. Long-term clinical deterioration was noted in 6 of 26 patients with nidus-type (23%) AVMs and was related to recurrent bleeding (n=3) or progressive venous congestion (n=3). Overall rebleed rate after presentation with hemorrhage was 7 in 145.5 patient-years (4.8%/y) if the lesion was not treated, 3 in 102 patient-years (2.9%/y) after partial treatment, and 0 in 47.5 patient-years (0%) after complete treatment. CONCLUSIONS: Nidus and fistulous spinal cord AVMs have different clinical features and obliteration rates, which may affect their long-term prognosis.
BACKGROUND AND PURPOSE: As a result of the rarity of spinal cord arteriovenous malformations (AVM), there are only a few series available that describe clinical features, outcome after treatment, and natural history of these lesions. In this article, we aim to describe our experience with both nidus- and fistulous-type spinal cord AVMs. METHODS: Forty-four consecutive patients with spinal cord AVMs were retrospectively reviewed. There were 26 patients with a nidus-type and 18 patients with a fistulous-type AVM. Treatments were performed with embolization (n=23), surgery (n=13), combined embolization-surgery (n=3), or conservative management (n=5). Clinical features, radiological findings, treatment results, and clinical outcomes were assessed. RESULTS:Patients with nidus-type AVMs were younger at presentation and more often presented with hemorrhage, with a higher proportion of hematomyelia than fistulous-type AVMs (P<0.05). Progression of clinical presentation from hemorrhage to congestive myelopathy during follow-up was noted in 5 patients, all of which had AVMs of the nidus type. Complete obliteration could be achieved more often in the fistulous type (72%) than in the nidus type (27%). Improved or stable clinical status at last follow-up was noted in 100% of fistulous-type and 77% of nidus-type patients. Long-term clinical deterioration was noted in 6 of 26 patients with nidus-type (23%) AVMs and was related to recurrent bleeding (n=3) or progressive venous congestion (n=3). Overall rebleed rate after presentation with hemorrhage was 7 in 145.5 patient-years (4.8%/y) if the lesion was not treated, 3 in 102 patient-years (2.9%/y) after partial treatment, and 0 in 47.5 patient-years (0%) after complete treatment. CONCLUSIONS: Nidus and fistulous spinal cord AVMs have different clinical features and obliteration rates, which may affect their long-term prognosis.
Authors: Frank Nketiah Boakye; Raphael Kofi Vowotor; Ronald Awoonor-Williams; Paa Kwesi Baidoo; Dickson Bandoh; Hadi Dodi Abdullah Journal: J West Afr Coll Surg Date: 2022-08-23
Authors: Paula Barreras; Kathryn C Fitzgerald; Maureen A Mealy; Jorge A Jimenez; Daniel Becker; Scott D Newsome; Michael Levy; Philippe Gailloud; Carlos A Pardo Journal: Neurology Date: 2017-12-01 Impact factor: 9.910