Spinal vascular malformation is an abnormality in the number and structure of blood vessels localized to the spinal cord. The age of onset is in years, with an average of about 20 years.
Etiology and pathology Spinal cord ischemia and injury are the main pathological mechanisms, and the possible pathological changes are.
Intraspinal hemorrhage, hematoma; vascular malformation or aneurysm compressing the spinal cord; spinal cord ischemia due to lesion steal flow; intravertebral venous hypertension.
Clinical manifestations progressive sensory and motor deficits, early bladder and rectal dysfunction, such as urinary and fecal incontinence, can lead to paraplegia in severe cases; nearly half of the patients have more clearly localized pain, such as lumbar, back, and leg; a few patients have sudden onset due to subarachnoid hemorrhage or intra-spinal cord hematoma, and female patients can be induced or aggravated by pregnancy and menstruation; the disease is classified according to the location, morphology, blood supplying arteries, and The disease can be classified as intramedullary arteriovenous malformation, peri-medullary arteriovenous fistula and dural arteriovenous fistula according to the location, morphology, blood supply artery and draining vein characteristics.
Spinal angiography: It is the only method to confirm the diagnosis of spinal arteriovenous malformation and can also provide valuable information for embolization treatment. Spinal angiography includes all the root arteries supplying the spinal cord, including the bilateral vertebral arteries, the thyrocervical trunk, the intercostal arteries, the lumbar artery, and the internal iliac artery, except for children who are under general anesthesia.
Myelography: This is the first test step to determine spinal cord disease and is relatively less financially burdensome to the patient. CT scan or spinal angiography is performed after the lesioned segment is found.
Scanning: After the lesion segment is clearly identified by myelography, a further more comprehensive understanding of the lesion is obtained.
Magnetic resonance imaging: It can provide a more comprehensive understanding of the location and size of the intramedullary arteriovenous malformation.
Differential diagnosis is mainly differentiated from the following diseases.
Intraspinal tumor: Most of the development of this disease is divided into three segments.
1. irritation phase: nocturnal pain or lying down pain is its special symptom, and patients are often forced to “sit and sleep”.
2. Partial compression of the spinal cord: the symptoms are motor and sensory impairment of the limbs below the plane of compression, with intramedullary tumors developing from above and below, while extramedullary tumors develop from below and above.
3.Complete compression stage of spinal cord: complete loss of motor, sensory and sphincter functions (urinary and fecal functions and sexual functions) below the plane of tumor.
Cervical spondylosis: there are also neck and shoulder pain and abnormal sensory manifestations, but the plane of sensory impairment is often irregular, and sphincter dysfunction is rarely seen. Intracranial arteriovenous malformations and aneurysms: The symptoms of meningeal irritation in subarachnoid hemorrhage caused by spinal cord vascular malformations need to be differentiated from subarachnoid hemorrhage caused by intracranial intracranial arteriovenous malformations and aneurysms.
Before treatment of this disease, diagnostic tests should be done to identify the different types of vascular malformations and to clarify the “context” of the lesions. Depending on the condition, different individual treatment plans should be developed. If the disease is not properly diagnosed and treated, the disease will gradually develop and may lead to paraplegia. The best hospitals in China for the treatment of this disease are Xuanwu Hospital in Beijing and Zhujiang Hospital in Guangzhou.
Surgical treatment: The indications for surgical treatment are.
1. The boundary of the deformity group is clear.
2.The lesion range is within two cones.
3.The lesion is located posteriorly and far away from the anterior spinal artery, and the surgery does not damage the arterial trunk.
4.The drainage vein does not block the surgical access.
5.Dural or peri-medullary arteriovenous fistula, the fistula is clear, and the lesion can be reached by surgery.
Endovascular embolization treatment: The principle of embolization is to slow down the abnormal blood flow between spinal arteries and veins through a safer route, gradually, to improve the function of the spinal cord, reduce the chance of bleeding, gradually form a thrombus, and finally make the arteriovenous malformation completely embolized. The application of a microcatheter, all the way to the edge of the malformation or the fistula, avoiding the main functional artery, and the injection of liquid gel (NBCA) can make some or all of the malformed vascular mass and the fistula disappear. It is appropriate to stop when most of the malformed vascular shadow disappears, and complete disappearance of the malformed vessels on the image should not be pursued.