Classification of spinal vascular malformations
Spinal vascular malformations are classified into four types:
- Type I — Dural arteriovenous fistula
The most common form, representing approximately 60 to 80% of cases. - Type II — Intramedullary arteriovenous malformation
The nidus is located in the parenchyma of the spinal cord, typically supplied by the anterior spinal artery, in front of the cord. - Type III — Intramedullary arteriovenous malformation with extramedullary extension
The feeding vessels originate from the vertebral plexuses, with extension beyond the spinal cord. - Type IV — Intradural perimedullary fistula
Supplied by the anterior spinal artery, it drains directly into a perimedullary vein (approximately 20% of cases).
How does a spinal vascular malformation present?
Dural and perimedullary fistulas
Often revealed by progressive symptoms: gait disturbances, sphincter dysfunction (myelopathy), or atypical sciatic-type pain (radicular syndrome).
Other malformations
May bleed with a risk of sudden deficit, or even paraplegia or tetraplegia. They may also present as subarachnoid hemorrhage.
How are they treated?
Arteriography is mandatory for the diagnosis of all these spinal vascular malformations. It allows:
- Confirmation of the diagnosis and precise localization of the spinal level of the malformation
- Evaluation of therapeutic options and initiation of embolization treatment when possible
While surgery is effective and relatively straightforward for the treatment of spinal dural fistulas, treatment of AVMs is more complex and often requires one or more embolization procedures. Radiotherapy is also a therapeutic option that may be considered based on surgical risks or in cases of small residual malformations difficult to access by other modalities.
How does a spinal vascular malformation present?
Dural and perimedullary fistulas
Often revealed by progressive symptoms: gait disturbances, sphincter dysfunction (myelopathy), or atypical sciatic-type pain (radicular syndrome).
Other malformations
May bleed with a risk of sudden deficit, or even paraplegia or tetraplegia. They may also present as subarachnoid hemorrhage.
How are they treated?
Arteriography is mandatory for the diagnosis of all these spinal vascular malformations. It allows:
- Confirmation of the diagnosis and precise localization of the spinal level of the malformation
- Evaluation of therapeutic options and initiation of embolization treatment when possible
While surgery is effective and relatively straightforward for the treatment of spinal dural fistulas, treatment of AVMs is more complex and often requires one or more embolization procedures. Radiotherapy is also a therapeutic option that may be
considered based on surgical risks or in cases of small residual malformations difficult to
access by other modalities.
Guide
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