Diagnosis and Treatment of Spinal Cord Arteriovenous Malformations

2015 ◽  
pp. 355-428 ◽  
Author(s):  
M. G. Yasargil
Keyword(s):  
Spinal Cord ◽  
Arteriovenous Malformations ◽  
Diagnosis And Treatment

Multisession CyberKnife Radiosurgery for Intramedullary Spinal Cord Arteriovenous Malformations

Neurosurgery ◽  
2006 ◽  
Vol 58 (6) ◽  
pp. 1081-1089 ◽  
Author(s):  
John Sinclair ◽  
Steven D. Chang ◽  
Iris C. Gibbs ◽  
John R. Adler
Keyword(s):  
Magnetic Resonance Imaging ◽  
Spinal Cord ◽  
Magnetic Resonance ◽  
Arteriovenous Malformations ◽  
Conus Medullaris ◽  
Spinal Angiography ◽  
Resonance Imaging ◽  
Intramedullary Spinal Cord ◽  
Cyberknife Radiosurgery

Abstract OBJECTIVE: Intramedullary spinal cord arteriovenous malformations (AVMs) have an unfavorable natural history that characteristically involves myelopathy secondary to progressive ischemia and/or recurrent hemorrhage. Although some lesions can be managed successfully with embolization and surgery, AVM size, location, and angioarchitecture precludes treatment in many circumstances. Given the poor outlook for such patients, and building on the successful experience with radiosurgical ablation of cerebral AVMs, our group at Stanford University has used CyberKnife (Accuray, Inc., Sunnyvale, CA) stereotactic radiosurgery (SRS) to treat selected spinal cord AVMs since 1997. In this article, we retrospectively analyze our preliminary experience with this technique. METHODS: Fifteen patients with intramedullary spinal cord AVMs (nine cervical, three thoracic, and three conus medullaris) were treated by image-guided SRS between 1997 and 2005. SRS was delivered in two to five sessions with an average marginal dose of 20.5 Gy. The biologically effective dose used in individual patients was escalated gradually over the course of this study. Clinical and magnetic resonance imaging follow-up were carried out annually, and spinal angiography was repeated at 3 years. RESULTS: After a mean follow-up period of 27.9 months (range, 3–59 mo), six of the seven patients who were more than 3 years from SRS had significant reductions in AVM volumes on interim magnetic resonance imaging examinations. In four of the five patients who underwent postoperative spinal angiography, persistent AVM was confirmed, albeit reduced in size. One patient demonstrated complete angiographic obliteration of a conus medullaris AVM 26 months after radiosurgery. There was no evidence of further hemorrhage after CyberKnife treatment or neurological deterioration attributable to SRS. CONCLUSION: This description of CyberKnife radiosurgical ablation demonstrates its feasibility and apparent safety for selected intramedullary spinal cord AVMs. Additional experience is necessary to ascertain the optimal radiosurgical dose and ultimate efficacy of this technique.

scholarly journals Diagnosis and Treatment of Bone Disease in Multiple Myeloma: Spotlight on Spinal Involvement

Scientifica ◽  
2013 ◽  
Vol 2013 ◽  
pp. 1-12 ◽  
Author(s):  
Patrizia Tosi
Keyword(s):  
Spinal Cord ◽  
Multiple Myeloma ◽  
Bone Marrow ◽  
Bone Resorption ◽  
Spinal Cord Compression ◽  
Bone Disease ◽  
Cord Compression ◽  
Diagnosis And Treatment ◽  
Conventional Chemotherapy ◽  
Spinal Involvement

Bone disease is observed in almost 80% of newly diagnosed symptomatic multiple myeloma patients, and spine is the bone site that is more frequently affected by myeloma-induced osteoporosis, osteolyses, or compression fractures. In almost 20% of the cases, spinal cord compression may occur; diagnosis and treatment must be carried out rapidly in order to avoid a permanent sensitive or motor defect. Although whole body skeletal X-ray is considered mandatory for multiple myeloma staging, magnetic resonance imaging is presently considered the most appropriate diagnostic technique for the evaluation of vertebral alterations, as it allows to detect not only the exact morphology of the lesions, but also the pattern of bone marrow infiltration by the disease. Multiple treatment modalities can be used to manage multiple myeloma-related vertebral lesions. Surgery or radiotherapy is mainly employed in case of spinal cord compression, impending fractures, or intractable pain. Percutaneous vertebroplasty or balloon kyphoplasty can reduce local pain in a significant fraction of treated patients, without interfering with subsequent therapeutic programs. Systemic antimyeloma therapy with conventional chemotherapy or, more appropriately, with combinations of conventional chemotherapy and compounds acting on both neoplastic plasma cells and bone marrow microenvironment must be soon initiated in order to reduce bone resorption and, possibly, promote bone formation. Bisphosphonates should also be used in combination with antimyeloma therapy as they reduce bone resorption and prolong patients survival. A multidisciplinary approach is thus needed in order to properly manage spinal involvement in multiple myeloma.

ARTERIOVENOUS MALFORMATIONS OF THE BRAIN AND SPINAL CORD

2002 ◽  
pp. 595-608
Author(s):  
Soke Miang Chng ◽  
Hortensia Alvarez ◽  
Georges Rodesch ◽  
Pierre Lasjaunias
Keyword(s):  
Spinal Cord ◽  
Arteriovenous Malformations ◽  
Brain And Spinal Cord ◽  
The Brain

scholarly journals CIRSE Standards of Practice on Diagnosis and Treatment of Pulmonary Arteriovenous Malformations

2019 ◽  
Vol 43 (3) ◽  
pp. 353-361 ◽  
Author(s):  
Stefan Müller-Hülsbeck ◽  
Leonardo Marques ◽  
Geert Maleux ◽  
Keigo Osuga ◽  
Jean-Pierre Pelage ◽  
...  
Keyword(s):  
Arteriovenous Malformations ◽  
Diagnosis And Treatment ◽  
Pulmonary Arteriovenous Malformations ◽  
Standards Of Practice

Arteriovenous Malformations of the Spinal Cord

2015 ◽  
pp. 238-266 ◽  
Author(s):  
M. Hurth ◽  
R. Houdart ◽  
R. Djindjian ◽  
A. Rey ◽  
M. Djindjian
Keyword(s):  
Spinal Cord ◽  
Arteriovenous Malformations

Endovascular Therapy for Arteriovenous Malformations and Fistulae in the Spinal Cord

1993 ◽  
Vol 10 (03) ◽  
pp. 227-242 ◽  
Author(s):  
Y. Gobin ◽  
Emmanuel Houdart ◽  
Alfredo Casasco ◽  
Jean-Jacques Merland
Keyword(s):  
Spinal Cord ◽  
Endovascular Therapy ◽  
Arteriovenous Malformations
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