The spinal epidural vascular malformations
Keywords:
spinal epidural space, vascular malformationsAbstract
STUDY DESIGN. Spinal epidural vascular malformations are extremely rare. Among them singled out arteriovenous fistulas, venous malformations and epidural varices. Now, little known about their diagnosis, management and results.
For the PURPOSE to study clinical course, therapeutic modalities, surgical technique and results the current study was undertaken.
MATERIAL AND METHODS: Forty-one cases of vascular malformations affecting the spinal epidural spaces were retrospectively reviewed. The methods of treatment, hystological similarities and differences between malformations at each type are reviewed.
RESULTS. Two patients had arteriovenous fistulas, tree had venous malformations and 36 patients had epidural varices with represent the major group of epidural malformations. The arteriovenous fistulas are a direct contact radicular artery with epidural veins. The pathology led to blood congestion in veins, their distention, and indirect cord compression or raised spinal venous pressure. The venous malformations are tingles of small veins in epidural spaces that caused spinal cord compression. The epidural varices are distension epidural veins unknown etiology. Venous outflow obstruction or congestion has been implicated in the etiology of some lumbar radicular syndromes. All cases of epidural varices manifesting themselves as masses within the lumbar spinal canal or adjacent foramina have been seen. Long time lumbar epidural varices have been infrequently described in the literature and rarely accepted as a primary pathophysiological entity. Now it considered as a primary pathology. The treatment of arteriovenous fistulas, and venous malformations included their devascularisation and resection. The treatment of epidural varices included their coagulation and neural decompression.
CONCLUSIONS. Knowledge of the existence of these pathological entities, its possible etiologies, and its imaging characteristics may assist in its recognition and improved management of patients with it.
References
1. Ilyinsky I, Vasin N. [Several problems of the clinical picture and diagnosis of defects in the development of spinal cord vessels]. Vopr Neirokhir. 1967 May-Jun;31(3):14-20. Russian. [PubMed]
2. Kuz'michev A. [Disorders of venous circulation in spinal osteochondrosis]. Vopr Neirokhir. 1967 May-Jun;31(3):20-24. Russian. [PubMed]
3. Coats T, King T. The diagnosis of dural spinal vascular malformations. Br J Neurosurg. 1991;5(6):609-615. [CrossRef]
4. D'Angelo V, Bizzozero L, Talamonti G, Ferrara M, Colombo N. Value of magnetic resonance imaging in spontaneous extradural spinal hematoma due to vascular malformation: Case report. Surgical Neurology. 1990;34(5):343-344. [CrossRef]
5. Demaerel P, Petré C, Wilms G, Plets C. Sciatica caused by a dilated epidural vein: MR findings. Eur Radiol. 1999;9(1): 113-114. [PubMed]
6. Dickman C, Zabramski J, Sonntag V, Coons S. Myelopathy due to epidural varicose veins of the cervicothoracic junction. Journal of Neurosurgery. 1988;69(6):940-941. [CrossRef]
7. Dickman C, Zabramski J, Sonntag V, Coons S. Myelopathy due to epidural varicose veins of the cervicothoracic junction. Journal of Neurosurgery. 1988;69(6):940-941. [CrossRef]
8. Djindjian M, Djindjian R, Hurth M, et al. [Spinal cord arteriovenous malformations and the Klippel-Trenaunay-Weber syndrome]. Surg Neurol. 1977 Oct;8(4):229-237. [PubMed]
9. Groen R. Spinal epidural hematoma following MI. Surg Neurol. 1999 Mar;51(3):349-350. [PubMed]
10. Gmbel U, Pia H, Vogelsang H. Lumbosacrale Gefanomalien als Ursache von Ischialgien. Acta Neurochirurgica. 1969;20(2-3):131-151. [CrossRef]
11. Hanley E, Howard B, Brigham C, Chapman T, Guilford W, Coumas J. Lumbar Epidural Varix as a Cause of Radiculopathy. Spine. 1994;19(18):2122-2126. [CrossRef]
12. Ivanovici F. Urine retention: An isolated sign in some spinal cord disorders. J Urol. 1970 Aug; 104(2):284-286. [PubMed]
13. LaBan M, Wang A, Shetty A, Sessa G, Taylor R. Varicosities of the paravertebral plexus of veins associated with nocturnal spinal pain as imaged by magnetic resonance venography: a brief report. American Journal of Physical Medicine & Rehabilitation. 1999;78(1):72-76.
14. Lai P, Ho J, Wang J, Pan H. Cervical radiculopathy due to epidural varicose veins. American Journal of Roentgenology. 1999;172(3):841-842. [CrossRef]
15. Lobitz В, Grate I. Acute Epidural Hematoma of the Cervical Spine. Southern Medical Journal. 1995;88(5):580-582. [CrossRef]
16. Maurice-Williams R. Spinal Dural Arteriovenous Malformations— A Treatable Cause of Progressive Paraparesis in Elderly People. Age Ageing. 1992;21(6):412-416. [CrossRef]
17. Muhonen M, Piper J, Moore S, Menezes A. Cervical Epidural Hematoma Secondary to an Extradural Vascular Malformation in an Infant. Neurosurgery. 1995;36(3):585???588. [CrossRef]
18. Oliver RJ, Greenwood RC, Smith D, Franklin C. Spinal varicosities complicated by pregnancy. Case report. Am J Obstet Gynecol. 1966 Jan 15; 94(2):258-260. [PubMed]
19. Yalniz G. Symptomatic lumbar foraminal epidural varix. Case report and review of the literature. Br J Neurosurg. 1997;11(2):159-160. [CrossRef]
20. Robertson W, Lee Y, Edmonson M. Spontaneous spinal epidural hematoma in the young. Neurology. 1979;29(1):120-120. [CrossRef]
21. Rosenfeld M. Sciatica caused by epidural venous anomalies. A case of L5-S1 sciatica 9 years after operation. Rev Rhum Mal Osteoartic. 1972 Jan; 39(1):47-49. French. [PubMed]
22. Rosenfeld M. Sciatica caused by epidural venous anomalies. A case of L5-S1 sciatica 9 years after operation. Rev Rhum Mal Osteoartic. 1972 Jan; 39(1):47-49. French. [PubMed]
23. Bücheler E, Frommhold H. Angiologische Untersuchungen bei spinalen Durchblutungsstörungen. Fortschr Röntgenstr. 1972;117(09):262-269. [CrossRef]
24. Yaşargil MG, DeLong W, Guarnaschelli J. Complete microsurgical excision of cervical extramedullary and intramedullary vascular malformations. Surg Neurol. 1975 Aug;4(2):211-224. [PubMed]
25. Zarski S., Styczynski T. Zylakowatosc dolnego odeinka kanalu kregowego. Neurol Neurochir Pol. 1978 Jan-Feb;12(1):67-72. Polish. [PubMed]
26. Zimmerman G, Weingarten K, Lavyne M. Symptomatic lumbar epidural varices. Journal of Neurosurgery. 1994;80(5):914-918. [CrossRef]
27. Zülch K. Pathogenetic and clinical observations in spinovascular insufficiency. Zentralbl Neurochir. 1976; 37(1): 1-13. [PubMed]
Downloads
How to Cite
Issue
Section
License
Copyright (c) 2000 Yuriy Zozulya, Eugene Slynko
This work is licensed under a Creative Commons Attribution 4.0 International License.
Ukrainian Neurosurgical Journal abides by the CREATIVE COMMONS copyright rights and permissions for open access journals.
Authors, who are published in this Journal, agree to the following conditions:
1. The authors reserve the right to authorship of the work and pass the first publication right of this work to the Journal under the terms of Creative Commons Attribution License, which allows others to freely distribute the published research with the obligatory reference to the authors of the original work and the first publication of the work in this Journal.
2. The authors have the right to conclude separate supplement agreements that relate to non-exclusive work distribution in the form of which it has been published by the Journal (for example, to upload the work to the online storage of the Journal or publish it as part of a monograph), provided that the reference to the first publication of the work in this Journal is included.
