Clinical syndromes, natural history, and pathophysiology of vascular lesions of the spinal cord.

With superselective angiography and careful clinical evaluation, dural fistulas were found to be the most important and most frequent origin of spinal arteriovenous malformations. Diagnosis may not be made for months or years, however, because dural fistulas never bleed and clinical deterioration is slow. Therapy with interventional techniques or microsurgery is relatively safe. Perimedullary fistulas and intramedullary angiomas mostly deteriorate quickly because of hemodynamic or hemorrhagic problems. Close teamwork of interventionalists and neurosurgeons is mandatory.