gms | German Medical Science

56. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
3èmes journées françaises de Neurochirurgie (SFNC)

Deutsche Gesellschaft für Neurochirurgie e. V.
Société Française de Neurochirurgie

07. bis 11.05.2005, Strasbourg

Microsurgical treatment in spinal plexiform AVMs

Mikrochirurgische Behandlung spinaler plexiformer AVMs

Meeting Abstract

  • corresponding author A. Boström - Department of Neurosurgery, University Hospital Aachen
  • M. H. T. Reinges - Department of Neurosurgery, University Hospital Aachen
  • M. Mull - Department of Neuroradiology, University Hospital Aachen
  • F. J. Hans - Department of Neurosurgery, University Hospital Aachen
  • A. Thron - Department of Neuroradiology, University Hospital Aachen
  • J. M. Gilsbach - Department of Neurosurgery, University Hospital Aachen

Deutsche Gesellschaft für Neurochirurgie. Société Française de Neurochirurgie. 56. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 3èmes journées françaises de Neurochirurgie (SFNC). Strasbourg, 07.-11.05.2005. Düsseldorf, Köln: German Medical Science; 2005. Doc11.05.-09.03

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgnc2005/05dgnc0213.shtml

Veröffentlicht: 4. Mai 2005

© 2005 Boström et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective

Plexiform spinal AVMs are rare lesions. In the literature only small series and anecdotal reports can be found. Prospective series elucidating the natural course, or the superiority of one treatment regimen against an other (e.g. surgery versus embolization versus conservative treatment) are missing. Microsurgical treatment of spinal AVMs often seems difficult because many are anatomically not suitable for primary microsurgical occlusion and therefore they are treated by neuroradiological interventions or are not treated at all.

Methods

Between 1989 and 2004 seventeen patients with a plexiform AVM were microsurgically treated in our departement. The history of symptoms ranged from 2 days – 48 month. 2 patients presented with subarachnoidal hemorrhage with no deficits, 5 with paraesthesia or pain with no deficits and 10 with clinical signs of a myelopathy, Five patients underwent partial embolisation prior to surgery. We have operated only on AVMs accessible from a dorsal or dorsolateral approach, using dilated veins or the AVM niddus itself to enter the cord for dissection of the malformation. The approach was performed via a laminectomy in 11 and hemilaminectomy in 6 patients.

Results

None of our patients suffered a permanent neurological deterioration. Two patients presented with a transient postoperative neurological deficit (e.g. bladder dysfunction, paraesthesia), most probably due to a suspected venous stasis. In 7 patients a post-op angiogram was performed that proved complete occlusion in 5 patients, a small residual AVM in 1 patient and a discrete feeder without a vein in 1 patient. MR-Angiogram one week post-operatively was performed in 1 patient that showed a regression of the myelon edema and small ventral vessels. In 8 patients a complete occlusion was assumed intraoperatively and in 1 patient the occlusion was incomplete but the patient improved.

Conclusions

Spinal cord AVMs are rare. The first choice for treatment is embolization. Therefore, surgical procedures remain sporadic events. We have only operated on AVMs accessible from a dorsal approach. The experience we made taught us, that in contrast to cerebral AVMs and aneurysms, spinal AVMs behave differently after incomplete occlusion either by surgery or embolization. The risk to suffer a neurological deficit seems to be relatively low even in residual AVMs. Therefore treatment should not aim to a complete occlusion, eventually causing an unacceptable high risk.