Embolization of spinal cord vascular malformations via the anterior spinal artery

During a 3 year period, 21 patients with spinal cord vascular malformations involving the anterior spinal artery were treated by embolization through this artery. Of four cases of extramedullary arteriovenous fistula, two patients embolized at an early stage showed excellent results, whereas results were mediocre in two patients who were paraplegic at embolization. Of 17 cases of intramedullary arteriovenous malformation (AVM), nine patients showed clinical improvement either with or without radiologic evidence of residual malformation; three patients had complications that led to clinical worsening; in the other five patients, results were mixed or inconclusive. Angiomyelotomography is recommended to diagnose extramedullary arteriovenous fistulae involving the anterior spinal artery. Pretherapeutic evaluation of intramedullary AVMs must consider the spinal cord level at which the malformation occurs. Angiotomography and temporary occlusion tests permit identification of collateral anastomoses before embolization. Respective criteria for surgery and embolization are defined. In cases where embolization is indicated, short-term results can generally be predicted.