gms | German Medical Science

Objective: The first choice treatment for the rare pathology of paediatric spinal arteriovenous malformations is currently performed by endovascular specialists. Despite the rapidly evolving interventional techniques several individuals remain with remnant or recurrent fistulas. In these patients microsurgery becomes obligatory. We evaluated our clinical and radiological long-term results to define treatment strategies in children with spinal AVMs.

Methods: The charts and images of seven young patients, aged between 9 and 23 years (mean 16 years) were retrospectively analysed. The AVMs (type II n=4, type IV n=3) were located at the craniocervical junction (n=1), the thoracic spine (n=4) and the conus (n=2). Intraoperative Doppler sonography and neuromonitoring were applied in all patients. Intraoperative angiography was performed in three individuals.

Results: Preoperative symptoms varied from subarachnoid haemorrhage, pain, numbness and incontinence to spastic or atactic gait disturbance and paraplegia. Six patients out of seven had been treated endovascularly before surgery. Doppler sonography was very helpful in locating the AVM (n=7). The unimpaired neurological function was assumed by regular SSEP, later approved by a thorough neurological examination. No treatment-related morbidity or mortality occurred. The longterm angiographic examination (2 to 5 years, mean 3 years) did not reveal any remnant or recurrent. The lonterm clinical examination (4 to 8 years, mean 5 years) resulted in improvement (n=1), stable conditions (n=5) and aggravation (n=1) of the preoperative symptoms.

Conclusions: Microsurgery for spinal AVMs of different types in young patients remains a reasonable therapeutical option to be considered in a multimodal treatment concept, when endovascular therapy is insufficient in occluding this rare type of spinal vascular lesions.