Vascular lesions of the brain such as DAVF's and AVM's can also be found in the spine. These conditions can cause severe pain, weakness, or complete paralysis. If treated early enough, the sequela of these lesions can be improve, or even completely resolve. As with similar lesions of the brain, treatment can be through endovascular embolization alone, or embolization combined with surgical resection.
As with fistulae of the brain, spinal DAVF’s are abnormal connections between the arteries of the spine and the veins draining the spinal cord. These usually cause a progressive myelopathy, characterized by lower extremity paresthesias and weakness, as the increased pressure in the draining veins of the spine causes edema of the spinal cord.
Often these lesions are not identified immediately, and in those cases, treatment is performed to help prevent progression of the disease. If the vascular nature of a patient’s weakness is identified early enough, treatment can lead to complete resolution of symptoms.
Endovascular embolization is performed by using a small catheter to select the arteries supplying the spine. Often there are multiple feeders to a DAVF. Once the feeders are identified, embolization is performed — usually with a liquid embolic agent — to obliterate the fistula.
As opposed to DAVF’s, which are generally acquired lesions, spinal AVM’s are abnormal collections of vessels that are usually congenital. As with AVM’s of the brain, these lesions can bleed, or cause increased venous pressure in the spine.
Spinal AVM’s, like spinal DAVF’s, can be difficult to diagnose. An initial work-up usually consists of a spinal MRI, which may only show signal abnormalities in the spinal cord, and not show the vascular abnormality directly. A spinal angiogram will show the lesion in detail, and will provide enough information for treatment planning.
For these lesions, treatment usually consists of surgical resection, endovascular embolization, or a combination of the two.
Outcomes are variable, and depend to a great extent on the location, size, and type of spinal AVM.
A patient with an unexplained myelopathy may have an occult vascular lesion such as a spinal DAVF or AVM. We would be happy to evaluate your patients with an idiopathic myelopathy at MMC for an underlying vascular cause for their symptoms.