Vascular diseases of the spinal cord: a review

Area of Science:

• Neurology
• Vascular Surgery
• Interventional Radiology

Background:

• Acute spinal cord ischemia syndrome (ASCIS) treatment draws from stroke and spinal cord injury data.
• Secondary prevention is vital, addressing aortic and cerebrovascular conditions.
• ASCIS can occur post-aortic surgery, including thoracic endovascular aortic repair (TEVAR).

Purpose of the Study:

• To outline treatment recommendations for ASCIS and spinal vascular lesions.
• To emphasize secondary prevention strategies for ASCIS.
• To detail management algorithms for various spinal vascular malformations.

Main Methods:

• Review of existing data from cerebral ischemic stroke, atherosclerotic vascular disease, and acute spinal cord injury.
• Discussion of proposed protocols for ASCIS post-aortic surgery.
• Analysis of treatment options for spinal vascular malformations (AVMs, AVFs, cavernous angiomas).

Main Results:

• ASCIS management requires both acute care and secondary prevention.
• Spinal cord hemorrhage treatment can be surgical and/or pharmacological.
• Spinal vascular malformations necessitate individualized treatment, with endovascular intervention often preferred for symptomatic lesions.
• Spinal dural AVFs can be treated endovascularly or surgically; surgery offers low complications if localized preoperatively.
• Spinal AVMs are typically managed endovascularly or via a multidisciplinary approach.
• Symptomatic spinal cavernous angiomas warrant surgical treatment, while asymptomatic deep lesions may be observed.

Conclusions:

• Comprehensive management of ASCIS includes secondary prevention and addressing underlying vascular pathologies.
• Individualized treatment algorithms are essential for spinal vascular malformations.
• Endovascular techniques play a significant role in managing spinal vascular lesions, offering less invasive options.