Spinal arterio-venous malformations: the classification, differentiated surgical tactics, treatment results

Yu. P. Zozulya, E. I. Slynko

Abstract


Results of 91 patients with spinal arterio-venous malformations and fistulas investigations and treatment since 1995 to 2005 are analyzed. The age of patients varied from 9 to 83 years, middle age was 42,9 years. A new classification of spinal arterio-venous malformation was developed. On the basis of anatomic features vascular malformations are divided on intramedullary, intradural perimedullary (located on a surface of a spinal cord), dural, epidural, intravertebral, and mixed — covering some adjacent areas. Angiostructural features of malformations, feeding and draining vessels have been analyzed. Surgical treatment was performed in all 91 patients, in endovascular interventions 13 were applied, in 70 — microsurgical operations and in 8 — combination of endovascular and microsurgical techniques. At open interventions we mainly applied posterior approaches. Anterior or anterolateral approaches were used in 8 patients. In 11 patients operative interventions were completed by spine stabilization. In all 91 patients vascular malformations were switched off from a blood-circulation totally. The following up period was from 4 months to 8,2 years. 32 patients after operation had a significant improvement, at 43 we observed partial improvement, at 10 — the neurological signs essentially have not changed, and at 6 — the neurological signs aggravated.


Keywords


spinal arteriovenous malformation; fistula; classification; endovascular; microsurgical operations

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