36
Vol. 66, No. 3 2015
Northeast Florida Medicine
Endovascular Neurosurgery
giogram. Early endovascular endeavors utilized polyvinyl alcohol
particulates to achieve obliterationof the fistula.However, thiswas
complicatedbyhighrecanalizationrates.
18
Morerecently,endovas-
cularsurgeonsutilizeliquidglueembolicslikeN-butylcyanoacrylate
(NBCA) and Onyx. In some cases, embolization is used as an
adjunct to surgical resection. Embolization is contraindicated in
cases where a spinal cord artery (radiculomedullary artery) arises
from the same pedicle as the feeder. Attempts with endovascular
treatment in these cases may result in either inadequate emboliza-
tion or spinal cord ischemia, if themedullary artery is occluded.
7,19
Embolization, even with liquid embolics, is still associated with
up to 54 percent recurrence.
16
Outcomes
Prognosis after treatment directly correlates with duration and
severity of pre-operative symptoms.
12,19,20
Otherwise, there has
been an inconsistency in the literature regarding prognosis after
treatment. Clinical improvement of the motor function ranges
from 25 percent to 100 percent.
20,21
Conclusion
Spinal vascular malformations are a rare and diverse group of
lesions that can pose challenges for clinicians both in diagnosis
and treatment. SDAVFs represent the largest proportion of this
heterogeneous group of lesions. Due to their relative rarity when
compared todegenerative spinal disorders, ahigh level of suspicion
must be maintained to make a timely diagnosis. Preoperative
workup with quality imaging, including MRI and angiogram, is
necessary to confirmthediagnosis, delineate the vascular anatomy,
anddetermine the effect on the spinal cordparenchyma.With this
knowledge the proper open, endovascular, or combined treatment
canbe selectedwithopportunity for increasedneurologic function
in these challenging patients.
v
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