Spinal cord arterio-venous shunts: From classification to therapeutic management - 15/05/21

Doi : 10.1016/j.neurol.2021.01.010

A. Consoli ^a,⁎ , O. Coskun ^a, F. Di Maria ^a, J. Gratieux ^a, S. Condette-Auliac ^a, S. Smadja ^b, A. Boulin ^a, G. Rodesch ^a
^a Diagnostic and interventional neuroradiology, hôpital FOCH, Constitutive Reference Center for Rare Diseases – Spinal Cord Arteriovenous Malformations, Avance Network, “FAVA Multi” Sector, 40, rue Worth, 92151 Suresnes, France
^b Interventional Neuroradiology, Fondation Rotschild Hospital, 29, rue Manin, 75019 Paris, France

^⁎Corresponding author. Diagnostic and interventional neuroradiology, hôpital FOCH, 40, rue Worth, 92151 Suresnes, France.Diagnostic and interventional neuroradiology, hôpital FOCH40, rue WorthSuresnes92151France

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Highlights

•	There are four types of spinal cord arteriovenous malformations: paraspinal, epidural, dural and intradural (the latter affecting the cord, the nerve roots or the filum terminale).
•	The veins represent the key factors responsible for the neurological symptoms (either acute by rupture or thrombosis, or progressive by congestion or compression of the cord).
•	MRI and MRA are the first choice examinations to perform in order to diagnose spinal cord arteriovenous malformations.
•	Digital subtraction angiography is mandatory to understand the angioarchitectonics of the vascular malformation and to plan a proper therapeutic strategy (mainly endovascular).
•	In intradural shunts, a well-performed endovascular treatment offers long-term clinical stability even if the arteriovenous malformation is not totally cured.

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Abstract

Spinal Cord Arterio-Venous shunts (SCAVSs) are a rare disease. The aim of this paper is to describe how we classify and consider management of SCAVSs in relation to the location of the shunt focusing mainly on intradural SCAVSs. The anatomical features of the SCAVSs together with data provided by MRI and CT scans allow identification of four types of SCAVSs: paraspinal, epidural, dural and intradural ones. Clinical and neuroradiologic characteristics are described for each entity as well as the therapeutic endovascular management at our institution between 2002 and 2020. The therapeutic management of SCAVSs, and in particular of intradural shunts, remains mainly based on endovascular treatment as a first-choice approach. Understanding properly the lesional and regional vascular anatomy is mandatory to plan an appropriate therapeutic strategy and obtain good clinical results stable at long term follow up.

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Keywords : Spinal cord, Arteriovenous malformations, Classification, Embolization, Clinical outcome