Tags

Type your tag names separated by a space and hit enter

Microsurgical management of glomus spinal arteriovenous malformations: pial resection technique: Clinical article.
J Neurosurg Spine. 2012 Jun; 16(6):523-31.JN

Abstract

OBJECT

Intramedullary, or glomus, spinal arteriovenous malformations (AVMs) are rare vascular lesions amenable to resection with or without adjuvant embolization. The authors retrospectively reviewed the senior author's (R.F.S.'s) surgical series of intramedullary spinal AVMs to evaluate clinical and radiographic outcomes.

METHODS

Detailed chart and radiographic reviews were performed for all patients with intramedullary spinal AVMs who underwent surgical treatment between 1994 and 2011. Presenting and follow-up neurological examination results were obtained and graded using the modified Rankin Scale (mRS) and McCormick Scale. Surgical technique, outcomes, complications, and long-term angiographic studies were reviewed.

RESULTS

During the study period, 20 patients (10 males and 10 females) underwent resection of glomus spinal AVMs. The mean age at presentation was 30 ± 17 years (range 7-62 years). The location of the AVMs was as follows: cervical spine (n = 10), thoracic spine (n = 9), and cervicothoracic junction (n = 1). The most common presenting signs and symptoms included paresis or paralysis (65%), paresthesias (40%), and myelopathy (40%). Perioperative embolization was performed in the majority (60%) of patients. Pial AVM resection was performed in 17 cases (85%). Angiographically verified AVM obliteration was achieved in 15 patients (75%). At a mean follow-up duration of 45.4 ± 52.4 months (range 2-176 months), 14 patients (70%) remained functionally independent (mRS and McCormick Scale scores ≤ 2). One perioperative complication occurred, yielding a surgical morbidity rate of 5%. Three symptomatic spinal cord tetherings occurred at a mean of 5.7 years after AVM resection. No neurological decline was observed after endovascular and surgical interventions. No deaths occurred. Long-term angiographic follow-up data were available for 9 patients (40%) at a mean of 67.6 ± 60.3 months (range 5-176 months) following AVM resection. Durable AVM obliteration was documented in 5 (83%) of 6 patients.

CONCLUSIONS

Intramedullary AVMs may be safely resected with satisfactory clinical and angiographic results. The pial resection technique, which provides subtotal AVM nidus resection, effectively devascularized these lesions, as confirmed on postoperative angiography, without violating the spinal cord parenchyma, thereby potentially reducing iatrogenic injury.

Links

Publisher Full Text

Authors+Show Affiliations

Velat GJ
Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Chang SW
No affiliation info available
Abla AA
No affiliation info available
Albuquerque FC
No affiliation info available
McDougall CG
No affiliation info available
Spetzler RF
No affiliation info available

MeSH

AdolescentAdultArteriovenous MalformationsChildEmbolization, TherapeuticFemaleHumansMaleMicrosurgeryMiddle AgedNeurologic ExaminationRadiographyRetrospective StudiesSpinal CordTreatment Outcome

Pub Type(s)

Journal Article

Language

eng

PubMed ID

22482421

Citation

Velat, Gregory J., et al. "Microsurgical Management of Glomus Spinal Arteriovenous Malformations: Pial Resection Technique: Clinical Article." Journal of Neurosurgery. Spine, vol. 16, no. 6, 2012, pp. 523-31.
Velat GJ, Chang SW, Abla AA, et al. Microsurgical management of glomus spinal arteriovenous malformations: pial resection technique: Clinical article. J Neurosurg Spine. 2012;16(6):523-31.
Velat, G. J., Chang, S. W., Abla, A. A., Albuquerque, F. C., McDougall, C. G., & Spetzler, R. F. (2012). Microsurgical management of glomus spinal arteriovenous malformations: pial resection technique: Clinical article. Journal of Neurosurgery. Spine, 16(6), 523-31. https://doi.org/10.3171/2012.3.SPINE11982
Velat GJ, et al. Microsurgical Management of Glomus Spinal Arteriovenous Malformations: Pial Resection Technique: Clinical Article. J Neurosurg Spine. 2012;16(6):523-31. PubMed PMID: 22482421.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Microsurgical management of glomus spinal arteriovenous malformations: pial resection technique: Clinical article. AU - Velat,Gregory J, AU - Chang,Steve W, AU - Abla,Adib A, AU - Albuquerque,Felipe C, AU - McDougall,Cameron G, AU - Spetzler,Robert F, Y1 - 2012/04/06/ PY - 2012/4/10/entrez PY - 2012/4/10/pubmed PY - 2012/8/11/medline SP - 523 EP - 31 JF - Journal of neurosurgery. Spine JO - J Neurosurg Spine VL - 16 IS - 6 N2 - OBJECT: Intramedullary, or glomus, spinal arteriovenous malformations (AVMs) are rare vascular lesions amenable to resection with or without adjuvant embolization. The authors retrospectively reviewed the senior author's (R.F.S.'s) surgical series of intramedullary spinal AVMs to evaluate clinical and radiographic outcomes. METHODS: Detailed chart and radiographic reviews were performed for all patients with intramedullary spinal AVMs who underwent surgical treatment between 1994 and 2011. Presenting and follow-up neurological examination results were obtained and graded using the modified Rankin Scale (mRS) and McCormick Scale. Surgical technique, outcomes, complications, and long-term angiographic studies were reviewed. RESULTS: During the study period, 20 patients (10 males and 10 females) underwent resection of glomus spinal AVMs. The mean age at presentation was 30 ± 17 years (range 7-62 years). The location of the AVMs was as follows: cervical spine (n = 10), thoracic spine (n = 9), and cervicothoracic junction (n = 1). The most common presenting signs and symptoms included paresis or paralysis (65%), paresthesias (40%), and myelopathy (40%). Perioperative embolization was performed in the majority (60%) of patients. Pial AVM resection was performed in 17 cases (85%). Angiographically verified AVM obliteration was achieved in 15 patients (75%). At a mean follow-up duration of 45.4 ± 52.4 months (range 2-176 months), 14 patients (70%) remained functionally independent (mRS and McCormick Scale scores ≤ 2). One perioperative complication occurred, yielding a surgical morbidity rate of 5%. Three symptomatic spinal cord tetherings occurred at a mean of 5.7 years after AVM resection. No neurological decline was observed after endovascular and surgical interventions. No deaths occurred. Long-term angiographic follow-up data were available for 9 patients (40%) at a mean of 67.6 ± 60.3 months (range 5-176 months) following AVM resection. Durable AVM obliteration was documented in 5 (83%) of 6 patients. CONCLUSIONS: Intramedullary AVMs may be safely resected with satisfactory clinical and angiographic results. The pial resection technique, which provides subtotal AVM nidus resection, effectively devascularized these lesions, as confirmed on postoperative angiography, without violating the spinal cord parenchyma, thereby potentially reducing iatrogenic injury. SN - 1547-5646 UR - https://www.unboundmedicine.com/medline/citation/22482421/Microsurgical_management_of_glomus_spinal_arteriovenous_malformations:_pial_resection_technique:_Clinical_article_ L2 - https://thejns.org/doi/10.3171/2012.3.SPINE11982 DB - PRIME DP - Unbound Medicine ER -