Author(s): Pigott T.; Elliot M.; Nahser H.
Source: British Journal of Neurosurgery; 2018; vol. 32 (no. 1); p. 84
Publication Date: 2018
Publication Type(s): Conference Abstract
Abstract:Objectives: Spinal arteriovenous malformations (AVM) are rare vascular lesions that represent a significant management challenge. Recent work highlights the importance of endovascular and conservative interventions in this group. We present our cumulative experience in the management of 12 patients. Design: Retrospective case series. Subjects: 12 cases were identified. All had complex spinal AVMs. 9 presented to our centre, 3 were referred from other neurosurgical units. Methods: Chart and database review. Results: Presentations were: Incidental finding (2), SAH (4), progressive neurological deficit (3) emergency presentation with acute deterioration (3). All patients underwent MRA and super selective angiogram. Treatment was based on risk profile and symptoms. 4 patients were managed conservatively. 6 had partial embolisation, targeted to the AVM aneurysmal component (4 had a single procedure, 2 had multiple aneurysms embolised in stages). 1 patient had a complete embolisation. 1 underwent surgical excision. Median follow up was 32 months. 9 remain under review. No patients had further neurological deterioration or SAH linked to AVM post embolisation. 3 improved neurologically. Following surgical excision 1 developed neuropathic pain requiring spinal cord stimulator implantation. Conclusions: We present our management of 12 complex spinal AVM’s. In our experience conservative approaches and targeted partial embolisation appear to significantly reduce the risk of sub arachnoid haemorrhage and progressive neurological deterioration.