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Spinal arteriovenous malformation.

E Q Regan1, D Spencer, J M Levy

  • 1Department of Orthopaedic Surgery, University of Illinois School of Medicine, Chicago 60612.

Journal of Spinal Disorders
|June 1, 1991
PubMed
Summary

This case study describes a large intradural arteriovenous malformation (AVM) presenting as a destructive spinal lesion. Due to bleeding risks and lack of neurological deficit, conservative management was chosen for this rare spinal vascular anomaly.

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<i>Reply</i>.

AJNR. American journal of neuroradiology·2017

Area of Science:

  • Neurosurgery
  • Vascular Neurology
  • Spinal Imaging

Background:

  • A rare case of a large intradural arteriovenous malformation (AVM) with bony and soft tissue components is presented.
  • The patient experienced a 20-year history of back pain, with imaging revealing a destructive spinal lesion.

Observation:

  • Plain radiographs showed a destructive lesion, while MRI demonstrated serpentine vascular structures and lytic bone lesions.
  • Biopsies, both needle and open, resulted in severe bleeding, highlighting the vascular nature of the lesion.
  • Selective spinal angiography confirmed a metameric juvenile type AVM supplied by the artery of Adamkiewicz.

Findings:

  • The arteriovenous malformation (AVM) was large (15 x 10 x 12 cm) and intradural, involving multiple spinal levels.

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  • No evidence of neoplasm was found.
  • The patient presented with no neurological deficit, a key factor in management decisions.

    • Implications:

    • Given the high risk of bleeding during intervention and the absence of neurological compromise, conservative management was selected.
    • This case underscores the challenges in diagnosing and managing spinal AVMs, particularly those with significant bony involvement.
    • Conservative follow-up was deemed the safest approach, emphasizing individualized treatment strategies for complex spinal vascular lesions.