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Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Spinal glomus-type arteriovenous malformations: microsurgical treatment in 20 cases
Azize Boström1, Timo Krings, Franz J Hans
1Department of Neurosurgery, University of Bonn Medical Center, Bonn, Germany. azize.bostroem@ukb.uni-bonn.de
Journal of Neurosurgery. Spine
|May 16, 2009
Summary
Glomus-type spinal arteriovenous malformations (AVMs) surgery may be indicated when embolization fails. Postoperative symptom improvement is common, even with residual AVMs, suggesting complete occlusion isn't always necessary.
Area of Science:
- Neurosurgery
- Vascular Neurology
- Interventional Radiology
Background:
- Glomus-type spinal arteriovenous malformations (AVMs) are rare, with limited data on their natural history and optimal treatment.
- Microsurgical intervention for spinal AVMs is often challenging due to anatomical limitations, frequently necessitating prior endovascular or conservative management.
Purpose of the Study:
- To evaluate the outcomes of microsurgical treatment for glomus-type spinal AVMs.
- To assess the safety and efficacy of surgical intervention in selected cases where embolization is not feasible.
Main Methods:
- A retrospective analysis of 20 patients with glomus-type spinal AVMs treated microsurgically between 1989 and 2005 at two German neurosurgical centers.
- Patients presented with varied symptoms including hemorrhage, pain, paresthesia, and myelopathy; seven underwent prior embolization.
- Surgical approach focused on AVMs accessible dorsally or dorsolaterally, with neurological status assessed using the McCormick classification.
Main Results:
- Microsurgery was performed via laminectomy or hemilaminectomy, often employing retrograde dissection from the venous side.
- Twenty percent of patients experienced temporary neurological worsening, but only 5% had permanent deficits.
- Postoperative angiography confirmed complete AVM occlusion in 11 of 14 assessed patients; incomplete occlusion occurred in 3, with one requiring reoperation.
Conclusions:
- Microsurgery can be a viable option for glomus-type spinal AVMs when embolization is not possible.
- Spinal AVMs can exhibit varied responses to incomplete occlusion, with symptom improvement frequently observed post-surgery despite residual lesions.
- Treatment may not always require complete occlusion if the risk of neurological deficit is high, balancing intervention risks with potential benefits.
