Spinal cord vascular disease (SCVD) Overview 1. incidence, etiology, natural history SCVD accounts for about 2% to 4% of all spinal cord diseases and 1/10 of cerebrovascular lesions. in acute stroke, it accounts for about 1.0% to 1.2%. With the improvement of diagnostic equipment and technology, its detection rate has been increasing year by year. Chen Gong, Department of Neurosurgery, Huashan Hospital, Fudan University The most common age of onset of SCVD is 30-70 years old. The most common sites are the thoracic and lumbar segments. Etiology: It is still not very clear, but most of them are known to be congenital abnormalities of spinal cord vascular development, but there are also acquired factors, such as trauma and infection. SCVD generally does not affect the life of the patient, but the progressively worsening neurological symptoms caused by it often lead to the loss of the patient’s ability to work and live independently, which seriously affects the patient’s quality of life and brings a heavy burden to the society and family. Due to its low prevalence and lack of awareness, it is often underdiagnosed and misdiagnosed, and its condition is complicated and the treatment effect is hardly satisfactory. These conditions are receiving increasing attention from scholars at home and abroad. 2.History The understanding and classification of SCVD has evolved with the development of research methods. Early analysis was mainly based on autopsy: in 1925 Sargent reported 21 patients with spinal vascular malformations. in 1943 Wyburn-Mason reviewed 110 cases of spinal vascular malformations, and these early reports considered most spinal vascular lesions to be venous lesions on the surface of the spinal cord. The revolutionary development came in the 1960s with the invention of selective spinal angiography by Doppman, Djindjian, and others, which first showed and recognized the vascular structure of spinal cord lesions and typed them more accurately. At that time, SCVD was divided into three major categories according to the angiography: type I, also known as “single tortuous vessel type”, which accounted for 80%-85%; type II, or mass type; type III, also known as naïve type; and the latter two accounted for 15%-20%. In the last century, in 1977, Kendall and Logue found in type I patients: an arteriovenous fistula (DAVF) at the nerve root cuff (on the dura mater), and after simple removal of the fistula, the patient’s symptoms improved. In 1977, Djindjian et al. recognized the discovery of arteriovenous fistulas on the soft membranes (i.e., PMAVF). With the use of MRI, a type previously thought to be rare, cavernous hemangioma (also called cavernous vascular malformation), was discovered, which was difficult to detect before the advent of CT. By understanding the pathophysiological basis of different types of SCVD, it was gradually recognized that each type of SCVD is a unique biological category and therefore needs to be classified. Classification of spinal cord and spinal vascular lesions: There are various classifications of SCVD, some of which are based on the location of the lesion, others on the hemodynamic characteristics and vascular constructive features, or a combination of the two. 1. Early classification: The modified classification by R. spetzler et al. is divided into three categories: (1) Spinal cord tumor-type lesions: (1) hemangioblastoma; (2) cavernous hemangioma. (2) spinal artery aneurysms. (3) Spinal cord arteriovenous lesions (SCAVLs): 1) arteriovenous fistulas (AVFs): 1) epidural type – such as DAVF; 2) intradural type – such as PMAVF. -(2) arteriovenous malformations (AVMs): (i) extradural and intramedullary types (ii) intramedullary types, which are also divided into: dense, diffuse and cone types.