脊髄動静脈奇形･動静脈瘻の塞栓術

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  • Interventional Radiology for Spinal Arteriovenous Malformations and Fistulae

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The final outcome of spinal cord vascular malformation (SCVM) is directly related to the prompt diagnosis and treatment of the abnormality. The primary objective of any therapeutic modality should be to obtain a neurologically normal patient, free of future risks in relation to the SCVM. Cure of spinal arteriovenous malformation is seldom obtained without morbidity. In patients in whom a complete cure is not possible at an acceptable level of risk, partial targeted embolization can be proposed with the aims of arresting or improving the clinical situation or modifying the natural history of the disease. Partial targeted embolization will obliterate the weak portion of the angioarchitecture, such as pseudo-aneurysms and varices resulting from previous hemorrhage, reduce the nidus volume, or slow down the flow through the malformation to decongest the venous drainage. These maneuvers improve the venous drainage of the normal spinal cord, often with beneficial effect. Our team’s embolic agent of choice is N-butyl cyanoacrylate (NBCA). Precious deposition of glue in the pathological network will not lead to any neurological deficit, as it will respect the spinal cord. The embryological and functional spinal cord micro vascular anatomy is essential.

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