Cavernous malformations of the spinal cord

Six patients with intramedullary cavernous malformations of the spinal cord are presented. Four men and two women presented with acute, subacute, or episodic signs and symptoms of spinal cord dysfunction, ranging in duration from 3 days to 25 years. All patients underwent operative resection of the malformation. Complete removal was achieved in five patients. Neurological function either stabilized or improved postoperatively in all patients; follow-up ranged from 4 to 84 months. The increasing awareness of the propensity for recurrent hemorrhage, clinical features, and resectability of these malformations are discussed.     

Embolization of vascular malformations of the spinal cord

Twelve patients with vascular malformations of the spinal cord have been treated by embolization at the Neuroradiological Department of the Ospedale Maggiore Niguarda Cà Granda from September 1981 to February 1984. Different materials and techniques have been used, including liophylised dura, Ivalon (PVA) and Isobutyl Cianoacrylate. All types of malformations have been encountered: dural AV fistulae, intramedullary AVMs, intradural extramedullary AV fistulae, extradural AVMs with intradural venous drainage. Nine patients improved following treatment and three remained unchanged. Embolization can be an alternative treatment to surgery and it is the treatment of choice in dural AV fistulae.     

Vascular malformations of the spinal cord (angiodysgenetic myelomalacia): a critique on its pathogenesis.

Two cases of angiodysgenetic myelomalacia are presented. Both patients had progressive weakness and sensory deficits in the lower extremities and vascular malformations of their spinal cords. The lesions were located on the dorsum of the spinal cord and the dorso-spinal roots. We believe the symptoms that developed later in life were due to spinal cord ischemia resulting from late degenerative changes in the vessels of the malformation and an ever increasing spinal "steal".     

Arteriovenous malformations of the dura mater

The presentation, angiographic findings, and treatment of eight dural arteriovenous malformations is reviewed. The majority presented as intracranial hemorrhage, one of which was an intracerebral hemorrhage, and an aneurysm was found in conjunction with two of the eight. Preoperative embolization of one of the malformations was used with an excellent result. Five of eight were treated surgically with a good outcome. Patient outcome, whether surgically treated or not, was good in all cases though follow-up is a maximum of 3 years, except for one case of 23 years.     

Phase contrast magnetic resonance of the spinal cord preliminary results in spinal cord arterio-venous malformations

Summary In spite of the recent advances in neuroradiology including the CT scan and the spin-echo-magnetic resonance (MR), accurate diagnosis of arteriovenous malformations (AVMs) involving the spinal cord is still based on selective angiography. This last procedure is invasive and needs to be repeated during the follow up. Phase contrast angio MR was performed with a 0.5 Tesla unit on 12 patients with an AVM involving the spinal cord (7 intramedullary AVMs, 4 perimedullary fistulas, and 1 dural fistula with perimedullary venous drainage); 4 of these were investigated before and after treatment. Angio MR showed abnormal vascular patterns within the spinal canal in all cases, without distinguishing between arteries and veins; the nidus of the intramedullary AVMs was displayed in all cases. Angio MR provided images of the whole AVMs comparable to the angiographic pictures, in contrast to the spin-echo MR, which provided only discontinued images of the vessels. The efficient range of velocity providing images varied, according to the type of the malformation (slow for dural fistulas, rapid for intra-medullary AVMs). In the 4 patients investigated after treatment, comparison of the images obtained before and after treatment permitted assessment of the degree of occlusion of the malformation. Finally, angio MR as a complement of spin-echo MR can now be used as a reliable tool for detection of spinal cord AVMs, assessing the indication for angiography, and, furthermore, it can probably replace most of the postoperative control angiographies. The value of the efficient imaging velocity is disputable but seems to depend on the haemodynamic characteristics of the malformation and may then serve as a guide to angiography.     

A case of idiopathic spinal cord herniation with duplicated dura mater

The patient was a 48-year-old man in whom a slow progression in walking difficulty occurred over a year. Magnetic resonance imaging (MRI) and computed tomography myelography (CTM) revealed duplicated dura mater from T1 to T12 and spinal cord herniation in the inner layer of the dura at the T4-T5 level. Idiopathic spinal cord herniation with duplicated dura mater was diagnosed, and surgery was performed. Intraoperative findings were of an elliptical defect of about 1 cm in the inner layer of the dura at the T4-T5 level, into which the spinal cord was herniated. A 1.5-cm cephalocaudal incision was created in the inner layer of the dura, and the incarcerated spinal cord was released, resulting in resolution of gait disturbance and an excellent postoperative clinical course. We reviewed the reports of 11 cases of idiopathic spinal cord herniation with duplicated dura mater and summarized the clinical and imaging characteristics as follows: 1) A hernial orifice was found at the T4-T6 level, 2) cross-sectional MRI or CTM showed a "snowman-like" deformation of the spinal cord, and 3) symptoms were often improved by widening the hernia orifice.     

Computed tomography in the management of spinal cord arteriovenous malformations

This is a report of two cases of intramedullary arteriovenous malformations (AVMs) where computed tomography (CT) was used as a complementary diagnostic investigation. CT scan features in these two cases are briefly discussed.     

CT血管成像诊断脊髓血管畸形

目的 观察CT血管成像（CTA）诊断脊髓血管畸形（SCVM）的价值。方法 回顾性分析85例经手术确诊SCVM患者CTA及数字减影血管造影（DSA）资料,以术中所见及术后临床诊断为金标准,计算CTA判断病变类型和范围的准确率,以及CTA显示增粗供血动脉及瘘口位置与DSA的符合率。结果 85例SCVM包括硬脊膜动静脉瘘（SDAVF）59例、脊髓周围动静脉瘘（SPAVF）10例、脊髓动静脉畸型（SAVM）12例及海绵状血管瘤（CM）4例。CTA判断病变类型和范围的准确率分别为85.88%(73/85)和92.94%(79/85)。除4例CM CTA及DSA结果均为阴性外,CTA显示81例SCVM供血动脉及瘘口位置与DSA的符合率分别为86.42%(70/81)和82.72%(67/81)。结论 脊髓CTA能较准确显示CM之外大部分SCVM病变范围、供血动脉及瘘口位置。     

Application of spinal dynamic computed tomography in the diagnosis of spinal cord arteriovenous malformations

Seventeen cases of spinal cord arteriovenous malformation (AVM) were evaluated by use of spinal dynamic computed tomography (CT). In the intravenous injection method, contrast medium was injected bolusly into the median cubital vein. In the intraarterial injection method, contrast medium was injected slowly into the feeding artery. In both methods, lesions were demonstrated in all cases. Three-dimensional localization of the lesions were more clearly demonstrated in the intraarterial injection method. Intravenous injection method was useful in the postoperative follow-up study due to its noninvasiveness.     

Vascular malformations as a cause of spontaneous spinal epidural haematoma

Summary Seven cases of spinal epidural haematoma occurred in a series of 2,500 neurosurgical procedures. Five of these seven cases were non-traumatic in origin. In four cases the bleeding could be ascribed to various types of vascular malformations. The clinical and histological features are described, and the relevance of these findings for surgical management is discussed.     

腰椎间盘突入硬脊膜内1例治疗体会

我院于2001年5月收治1例腰椎间盘的髓核突入硬脊膜内的患者，现将治疗体会报告如下。