eMedicine Specialties > Neurosurgery > Vascular

Vascular Malformations of the Spinal Cord: Workup

Author: James S Harrop, MD, Associate Professor, Departments of Neurological and Orthopedic Surgery, Jefferson Medical College
Coauthor(s): Pascal M Jabbour, MD, Cerebrovascular Fellowship, Department of Neurosurgery, Thomas Jefferson University Hospital; Gregory J Przybylski, MD, Professor of Neurological Surgery, Seton Hall University, School of Graduate Medical Education; Director of Neurosurgery, New Jersey Neuroscience Institute, JFK Medical Center
Contributor Information and Disclosures

Updated: Sep 16, 2009

Workup

Laboratory Studies

  • No laboratory studies are useful for the diagnosis of spinal cord vascular malformations. However, if the patient presents with symptoms of subarachnoid hemorrhage, a lumbar puncture or CT scan demonstrates blood in the spinal fluid.

Imaging Studies

  • Plain radiography is not usually helpful for diagnosis.
  • CT scanning may demonstrate dilated vessels in the thecal sac, but findings are usually normal. If a patient presents with symptoms of subarachnoid hemorrhage, CT scanning demonstrates blood in the spinal fluid.
  • Myelography findings, with or without CT, show dilated vessels in the intradural space.
    • This imaging modality is very sensitive and shows these abnormalities in detail.
    • This is an invasive procedure that requires injection of a contrast agent into the thecal sac. Postprocedure headaches are not uncommon.
  • MRI is a noninvasive imaging modality.
    • The soft tissue and neural elements are visualized in detail with this technique.
    • Dilated intradural vessels can be seen as flow voids or can be seen filling with contrast. Edema or hemorrhage in the spinal cord parenchyma can be assessed. The exact fistula site cannot be localized.
  • MRA or CTA are noninvasive modalities being used to identify any abnormal vessels. However, the resolution of these modalities is not to yet high enough.
  • Arteriography is the criterion standard modality for visualizing arteriovenous malformations (AVMs).
    • This is a dynamic study that allows visualization of the pathology in real time, allowing assessment of high-flow versus low-flow AVMs. In addition, the location of the fistula can be visualized.
    • Arteriography is an invasive procedure that may cause morbidity such as spinal cord ischemia, cerebral vascular accident, and vascular dissection.

Diagnostic Procedures

If the patient presents with symptoms of subarachnoid hemorrhage, a lumbar puncture demonstrates blood in the spinal fluid.

More on Vascular Malformations of the Spinal Cord

Overview: Vascular Malformations of the Spinal Cord
Workup: Vascular Malformations of the Spinal Cord
Treatment: Vascular Malformations of the Spinal Cord
Follow-up: Vascular Malformations of the Spinal Cord
Multimedia: Vascular Malformations of the Spinal Cord
References
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References

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Further Reading

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Keywords

vascular malformations of the spinal cord, spinal cord vascular malformations, arterial venous malformations of the spinal cord, arterial venous fistulas of the spinal cord, dural spinal arterial venous fistula, AVF, dural spinal arterial venous malformation, AVM, spinal cord malformation, spinal cord deformity, arteriovenous malformation, arteriovenous fistula, spinal arteriovenous malformation, spinal arteriovenous fistula, glomus AVM, spinal vascular malformation, spinal dural fistula, intradural AVM, dural AVF

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Contributor Information and Disclosures

Author

James S Harrop, MD, Associate Professor, Departments of Neurological and Orthopedic Surgery, Jefferson Medical College
James S Harrop, MD is a member of the following medical societies: American Association of Neurological Surgeons, American College of Surgeons, American Spinal Injury Association, Cervical Spine Research Society, Congress of Neurological Surgeons, and North American Spine Society
Disclosure: Depuy spine Consulting fee Consulting; Medtronic Consulting fee Consulting; stryker spine Honoraria Speaking and teaching

Coauthor(s)

Pascal M Jabbour, MD, Cerebrovascular Fellowship, Department of Neurosurgery, Thomas Jefferson University Hospital
Pascal M Jabbour, MD is a member of the following medical societies: Congress of Neurological Surgeons
Disclosure: Nothing to disclose.

Gregory J Przybylski, MD, Professor of Neurological Surgery, Seton Hall University, School of Graduate Medical Education; Director of Neurosurgery, New Jersey Neuroscience Institute, JFK Medical Center
Gregory J Przybylski, MD is a member of the following medical societies: American Association of Neurological Surgeons, American Medical Association, Congress of Neurological Surgeons, and North American Spine Society
Disclosure: DepuySpine Consulting fee Speaking and teaching; United HealthCare Consulting fee Consulting; Humana Consulting fee Consulting; Coding Institute Honoraria Independent contractor

Medical Editor

Paul L Penar, MD, Professor, Department of Surgery, Division of Neurosurgery, University of Vermont School of Medicine
Paul L Penar, MD is a member of the following medical societies: Alpha Omega Alpha, American Association of Neurological Surgeons, and Congress of Neurological Surgeons
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Allen R Wyler, MD, Former Medical Director, Northstar Neuroscience, Inc
Allen R Wyler, MD is a member of the following medical societies: American Academy of Neurological and Orthopaedic Surgeons, American Association of Neurological Surgeons, and Society of Neurological Surgeons
Disclosure: Nothing to disclose.

CME Editor

Paolo Zamboni, MD, Professor of Surgery, Chief of Day Surgery Unit, Chair of Vascular Diseases Center, University of Ferrara, Italy
Paolo Zamboni, MD is a member of the following medical societies: American Venous Forum and New York Academy of Sciences
Disclosure: Nothing to disclose.

Chief Editor

Allen R Wyler, MD, Former Medical Director, Northstar Neuroscience, Inc
Allen R Wyler, MD is a member of the following medical societies: American Academy of Neurological and Orthopaedic Surgeons, American Association of Neurological Surgeons, and Society of Neurological Surgeons
Disclosure: Nothing to disclose.

 
 
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