scholarly journals Spinal vascular malformations: an historical perspective

2006 ◽  
Vol 21 (6) ◽  
pp. 1-7 ◽  
Author(s):  
Perry Black
Keyword(s):  
Middle Ages ◽  
Historical Perspective ◽  
Vascular Malformations ◽  
Vascular Lesions ◽  
Spinal Vascular Malformations ◽  
Time Period ◽  
The 1960S ◽  
Biological Entities ◽  
Modern Era

✓In this historical perspective, the author identifies three epochs in the development of the concepts and treatment of spinal vascular lesions: 1) early observations (1860s–1912), with the lesions during this time period recognized only at autopsy; 2) the “middle ages” (1912–1960), with surgical intervention sporadic and yielding dismal results; and 3) the modern era (beginning in the 1960s), coincident with parallel dramatic advances in radiology, microsurgical instrumentation, and anesthesiology. These advances resulted in a better understanding of the pathophysiological aspects and angioarchitecture of the lesions. Whereas the nomenclature of the lesions in the past was confusing, a new understanding of these diseases that has emerged during the modern era has permitted refinement of the classification of the lesions as distinct biological entities. Modern diagnostic imaging has enabled identification of patients who may benefit from surgical or embolic occlusion, and treatment has become rationally based. Future progress in the management of spinal vascular lesions may be anticipated, with improvement in noninvasive imaging for early detection of suspected abnormalities. Furthermore, advances in spinal cord neuroprotection may expand the range of future options for surgical or embolic intervention.

scholarly journals Introduction: Spinal Vascular Malformations

2009 ◽  
Vol 26 (1) ◽  
pp. E1 ◽  
Author(s):  
Edward H. Oldfield
Keyword(s):  
Spinal Cord ◽  
Vascular Malformations ◽  
Vascular Lesions ◽  
Successful Management ◽  
Anatomical Features ◽  
Spinal Vascular Malformations ◽  
Cord Injury ◽  
Selective Arteriography ◽  
The 1960S ◽  
Made In

From the earliest observations of spinal vascular malformations, successful management has been challenging. Initially the challenges were diagnosing, understanding, and treating these lesions. They were originally considered all to be the same, or at least to be a single general type, of disease. With the introduction of selective spinal arteriography in the 1960s and more recently with the introduction and widespread use of MR imaging, the initial challenge of diagnosing spinal vascular malformations was overcome, and significant progress has been made in understanding their anatomy as well as the pathophysiology that underlies the myelopathy commonly associated with them. The anatomical features defined by selective arteriography and the observations permitted with the operating microscope ultimately led to distinctions between the major categories of the vascular lesions affecting the spinal cord; these distinctions were based on the lesions' anatomy, epidemiology, and the mechanism of spinal cord injury.

Volumetric T2-weighted MRI improves the diagnostic accuracy of spinal vascular malformations: comparative analysis with a conventional MR study

2019 ◽  
Vol 11 (10) ◽  
pp. 1019-1023 ◽  
Author(s):  
Santhosh Kumar Kannath ◽  
Adhithyan Rajendran ◽  
Bejoy Thomas ◽  
Jayadevan Enakshy Rajan
Keyword(s):  
Diagnostic Accuracy ◽  
Likelihood Ratio ◽  
Vascular Malformations ◽  
Positive Likelihood Ratio ◽  
Negative Likelihood Ratio ◽  
Vascular Lesions ◽  
Volumetric Mri ◽  
Spinal Vascular Malformations ◽  
Sensitivity Specificity ◽  
T2 Mri

BackgroundTo date, very little study of the importance of a volumetric T2-weighted MR sequence in the evaluation of spinal vascular malformations (SVMs) has been carried out.ObjectiveTo determine the utility and accuracy of a volumetric T2 MR sequence compared with conventional T2 in the diagnosis of SVMs.MethodsRetrospective analysis of all patients who underwent spinal DSA for suspected SVMs was conducted. Conventional T2 and volumetric T2 MR images were analysed for the presence of flow voids and parenchymal changes, and SVMs were characterized. The sensitivity, specificity, and overall diagnostic accuracy of these MRI diagnoses were calculated.ResultsOf 89 subjects included in the final analysis, 70 patients had angiographically proved SVMs (38 patients with spinal cord arteriovenous malformations [SCAVM—intramedullary or perimedullary] and 32 cases of spinal dural arteriovenous fistula (SDAVF)) and the remaining 19 subjects were normal. The sensitivity and specificity for identification of SVMs were 98.1% and 90% for volumetric T2 sequences, compared with 82.8% and 89.4% for conventional T2 MRI, respectively. For characterization of spinal vascular lesions, volumetric MRI showed high sensitivity, specificity, and accuracy for SDAVF (100%, 90%, 97%, respectively) compared with conventional T2 MRI (71.8%, 89%, 79%, respectively). The positive likelihood ratio was high and negative likelihood ratio was zero for volumetric MRI evaluation of SDAVF, while these ratios were comparable between the two sequences for SCAVM.ConclusionVolumetric T2 MRI is highly sensitive for the detection of SVMs, especially for SDAVF. Volumetric T2 MRI could be introduced into routine clinical practice in the screening of suspected SVMs.

scholarly journals Endovascular management of spinal vascular malformations: history and literature review

2009 ◽  
Vol 26 (1) ◽  
pp. E7 ◽  
Author(s):  
Ricky Medel ◽  
R. Webster Crowley ◽  
Aaron S. Dumont
Keyword(s):  
Endovascular Therapy ◽  
Surgical Intervention ◽  
Vascular Malformations ◽  
Therapeutic Tool ◽  
First Line ◽  
Spinal Vascular Malformations ◽  
First Line Therapy ◽  
Treatment Paradigm ◽  
The 1960S

Spinal vascular malformations represent a complex group of entities whose treatment paradigm continually evolves. Given the ever-increasing role of endovascular therapy, it is the goal of the authors to review the current literature regarding this therapeutic tool and to provide recommendations guiding management. A thorough literature search was conducted using Medline, with subsequent articles being identified through cross-referencing. The analysis revealed that, since its introduction in the 1960s, endovascular therapy has been used to manage the entire spectrum of spinal vascular malformations, during which period it has undergone considerable technological and technical evolution. As such, embolization has proved of growing therapeutic utility, largely resulting from the mounting evidence supporting its safety and efficacy, in addition to the inherent minimally invasive nature. This alternative to surgical intervention will be increasingly used as first-line therapy in spinal vascular malformations.

Rotational angiography for diagnosis and surgical planning in the management of spinal vascular lesions

2012 ◽  
Vol 32 (5) ◽  
pp. E6 ◽  
Author(s):  
Alexander E. Ropper ◽  
Ning Lin ◽  
Bradley A. Gross ◽  
Hekmat K. Zarzour ◽  
Ruth Thiex ◽  
...  
Keyword(s):  
Vascular Malformations ◽  
Three Dimensional ◽  
Vascular Pathology ◽  
Vascular Lesions ◽  
Spinal Angiography ◽  
Rotational Angiography ◽  
Spinal Vascular Malformations ◽  
Significant Difference ◽  
Surgical Treatment Planning

Object The management of spinal vascular malformations has undergone significant evolution with the advent of advanced endovascular and angiographic technology. Three-dimensional rotational spinal angiography is an advanced tool that allows the surgeon to gain a better appreciation of the anatomy of these spinal vascular lesions and their relation to surrounding structures. This article describes the use of rotational angiography and 3D reconstructions in the diagnosis and management of spinal vascular malformations. Methods The authors present representative cases involving surgical treatment planning for spinal vascular malformations with focus on the utility and technique of rotational spinal angiography. They report the use of rotational spinal angiography for a heterogeneous collection of vascular pathological conditions. Results Eight patients underwent rotational spinal angiography in addition to digital subtraction angiography (DSA) for the diagnosis and characterization of various spinal vascular lesions. Postprocessed images were used to characterize the lesion in relation to surrounding bone and to enhance the surgeon's ability to precisely localize and obliterate the abnormality. The reconstructions provided superior anatomical detail compared with traditional DSA. No associated complications from the rotational angiography were noted, and there was no statistically significant difference in the amount of radiation exposure to patients undergoing rotational angiography relative to traditional angiography. Conclusions The use of rotational spinal angiography provides a rapid and powerful diagnostic tool, superior to conventional DSA in the diagnosis and preoperative planning of a variety of spinal vascular pathology. A more detailed understanding of the anatomy of such lesions provided by this technique may improve the safety of the surgical approach.

scholarly journals Classification of Spinal Vascular Malformations

2009 ◽  
Vol 22 (1_suppl) ◽  
pp. 97-106
Author(s):  
T. Krings ◽  
P.L. Lasjaunias ◽  
S. Geibprasert ◽  
F.J. Hans ◽  
A.K. Thron ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Rare Diseases ◽  
Vascular Malformations ◽  
Arteriovenous Fistulas ◽  
Spinal Vascular Malformations ◽  
Choice Of Treatment ◽  
Meningeal Arteries ◽  
Brain Avms ◽  
The Brain

Spinal vascular malformations are rare diseases with a wide variety of neurological presentations. Their classification depends on the differentiation of shunting versus non-shunting lesions, the latter being the spinal cord cavernomas. In the shunting lesions, the next step in the proposed classification scheme is related to the feeding artery which can subdivide the dural vascular shunts from the pial vascular malformations: while those shunts that are fed by radiculomeningeal arteries (i.e. the counterparts of meningeal arteries in the brain) constitute the dural arteriovenous fistulas, the shunts that are fed by arteries that would normally supply the spinal cord (i.e. the radiculomedullary and radiculopial arteries) are the pial cord arteriovenous malformations (whose cranial counterparts are the brain AVMs). Depending on the type of transition between artery and vein the latter pial AVMs can be further subdivided into glomerular (plexiforme or nidus-type) AVMs with a network of intervening vessels in between the artery and vein and the fistulous pial AVMs. The last step in the classification then describes whether the type of fistula has a high or a low shunting volume which will differentiate the “Macro-” from the “Micro-”fistulae. The proposed classification is therefore based on a stepwise analysis of the shunt including its arterial anatomy, its nidus-architecture and its flow-volume evaluation. The major advantage of this approach is that it leads to a subclassification with direct implications on the choice of treatment, thereby constituting a simple and practical approach to evaluate these rare diseases.

Venous-predominant parenchymal arteriovenous malformation: a rare subtype with a venous drainage pattern mimicking developmental venous anomaly

2008 ◽  
Vol 108 (6) ◽  
pp. 1142-1147 ◽  
Author(s):  
So-Hyang Im ◽  
Moon Hee Han ◽  
Bae Ju Kwon ◽  
Jung Yong Ahn ◽  
Cheolkyu Jung ◽  
...  
Keyword(s):  
Arteriovenous Malformation ◽  
Vascular Malformation ◽  
Vascular Malformations ◽  
Gamma Knife Radiosurgery ◽  
Vascular Lesions ◽  
Arterial Phase ◽  
Developmental Venous Anomaly ◽  
Venous Anomaly ◽  
Arteriovenous Shunts

Object Considerable confusion exists in the literature regarding the classification of cerebrovascular malformations and their clinical significance. One example is provided by the atypical developmental venous anomaly (DVA) with arteriovenous shunt, because it remains controversial whether these lesions should be classified as DVAs or as atypical cases of other subtypes of cerebrovascular malformations. The purpose of this study was to clarify the classification of these challenging vascular lesions in an effort to suggest an appropriate diagnosis and management strategy. Methods The authors present a series of 15 patients with intracranial vascular malformations that were angiographically classified as atypical DVAs with arteriovenous shunts. This type of vascular malformation shows a fine arterial blush without a distinct nidus and early filling of dilated medullary veins that drain these arterial components during the arterial phase on angiography. Those prominent medullary veins converge toward an enlarged main draining vein, which together form the caput medusae appearance of a typical DVA. Results Based on clinical, angiographic, surgical, and histological findings, the authors propose classifying these vascular malformations as a subtype of an arteriovenous malformation (AVM), rather than as a variant of DVA or as a combined vascular malformation. Conclusions Correct recognition of this AVM subtype is required for its proper management, and its clinical behavior appears to follow that of a typical AVM. Gamma Knife radiosurgery appears to be a good alternative to resection, although long-term follow-up results require verification.

Data Communication Pathway for Sensing Guidewire at Proximal Side: A Review

2017 ◽  
Vol 11 (2) ◽  
Author(s):  
Hoda Sharei ◽  
Ronald Stoute ◽  
John J. van den Dobbelsteen ◽  
Maria Siebes ◽  
Jenny Dankelman
Keyword(s):  
English Language ◽  
Web Of Science ◽  
Data Communication ◽  
Cost Effective ◽  
Comprehensive Overview ◽  
Time Period ◽  
The 1960S ◽  
Cardiovascular Interventions ◽  
Communication Pathway

As the connection at the proximal tip plays an important role for sensing guidewires, we compared various sensing guidewires with regard to their proximal connectors. The strengths and weaknesses of each are discussed and recommendations for future development are provided. A literature search limited to the English language for the time period from the 1960s to the 2010s has been performed on the USPTO database, Espacenet, and Web of Science. The results have been categorized on the basis of the connector design. A comprehensive overview and classification of proximal connectors for sensing guidewires used for cardiovascular interventions is presented. The classification is based on both the type of connector (fixed or removable) and the type of connection (physical, wireless, or a combination). Considering the complexity of the currently prototyped and tested connectors, future connector development will necessitate an easy and cost-effective manufacturing process that can ensure safe and robust connections.

scholarly journals 3D DCE-MRA in spinal vascular malformations

2021 ◽  
Author(s):  
Jibin Cao ◽  
Sijia Gao ◽  
Wenge Sun ◽  
Lingling Cui
Keyword(s):  
Spinal Cord ◽  
Surgical Treatment ◽  
Clinical Symptoms ◽  
Vascular Malformations ◽  
High Sensitivity ◽  
Vascular Lesions ◽  
Arterial Blood Supply ◽  
3 Dimensional ◽  
Spinal Vascular Malformations ◽  
Arterial Blood

Abstract Purpose: This study was carried out to investigate whether 3.0T dynamic enhanced 3 dimensional magnetic resonance angiography (3D DCE-MRA) could identify spinal cord vascular malformations efficiently.Material and Methods: 32 suspected cases of spinal vascular disease with MR imaging and clinical symptoms were detected using DCE-MRA. 28 patients were valued through DSA for 3-5 days, and surgical treatment was performed on 24 patients. Results: DCE-MRA was used to examine all the cases which recognized abnormal vascular lesions clearly, and 28 cases were consistent with DSA or surgical diagnosis. The arterial blood supply was evaluated accurately in 28 cases. The findings were correct in 26 cases.Conclusion: 3.0T DCE-MRA features high sensitivity and accuracy in detecting and characterizing SVMs, especially SDAVF.

scholarly journals Intramedullary Cavernoma: Case Report and Literature Review

2019 ◽  
Vol 2 (1) ◽  
Keyword(s):  
Spinal Cord ◽  
Vascular Malformations ◽  
Cord Compression ◽  
Lower Limbs ◽  
Low Flow ◽  
Vascular Lesions ◽  
Spinal Vascular Malformations ◽  
Patient Reported ◽  
Spinal Cord Compression Syndrome ◽  
Chronic Myelopathy

Introduction: Cavernomas are benign vascular anomalies consisting of cavities where the blood circulates at low flow and at low pressure. Intramedullary localization is unusual, represents approximately 5 to 12% of spinal vascular malformations and 3% of intra-dural vascular malformations (5% of medullary vascular lesions). Observation: A patient, aged 59, consulted for the abrupt installation of moderate back pain followed by predominant muscle weakness in the two lower limb of progressive worsening, responsible for gait disorders. The patient reported thermal hypoesthesia and heaviness of the two lower limbs that had been evolving for two years. The examination found a dorsal spinal cord compression syndrome. On the MRI, there were abnormalities of intramedullary signal of the dorsal (D11) spinal cord with bleeding stigmas suggestive of intramedullary cavernomas. Conclusion: The management of the medullary cavernoma is essentially neurosurgical with complete microsurgical resection of the malformation. In the absence of surgical treatment, evolution can be to chronic myelopathy or neurological aggravation.

scholarly journals Intramedullary Cavernoma: Case Report and Literature Review

2019 ◽  
Vol 2 (1) ◽  
Keyword(s):  
Spinal Cord ◽  
Vascular Malformations ◽  
Cord Compression ◽  
Lower Limbs ◽  
Low Flow ◽  
Vascular Lesions ◽  
Spinal Vascular Malformations ◽  
Patient Reported ◽  
Spinal Cord Compression Syndrome ◽  
Chronic Myelopathy

Introduction: Cavernomas are benign vascular anomalies consisting of cavities where the blood circulates at low flow and at low pressure. Intramedullary localization is unusual, represents approximately 5 to 12% of spinal vascular malformations and 3% of intra-dural vascular malformations (5% of medullary vascular lesions). Observation: A patient, aged 59, consulted for the abrupt installation of moderate back pain followed by predominant muscle weakness in the two lower limb of progressive worsening, responsible for gait disorders. The patient reported thermal hypoesthesia and heaviness of the two lower limbs that had been evolving for two years. The examination found a dorsal spinal cord compression syndrome. On the MRI, there were abnormalities of intramedullary signal of the dorsal (D11) spinal cord with bleeding stigmas suggestive of intramedullary cavernomas. Conclusion: The management of the medullary cavernoma is essentially neurosurgical with complete microsurgical resection of the malformation. In the absence of surgical treatment, evolution can be to chronic myelopathy or neurological aggravation.

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