eMedicine Specialties > Neurosurgery > Vascular

Vascular Malformations of the Spinal Cord: Follow-up

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

Outcome and Prognosis

Patient outcome is directly related to neurologic function at the time of the surgical intervention. Patients who are able to ambulate when treated tend to remain ambulatory and may increase their strength with physical therapy. Patients who do not have antigravity strength in the lower extremities before treatment are unlikely to regain neurologic function to the point of ambulation. Patients who present with bowel or bladder dysfunction have a limited return of neurologic function.

Diagnosing these lesions early and providing appropriate treatment is important if patients are to achieve an optimal neurologic outcome.

Future and Controversies

MRI should be the first diagnostic modality performed when a spinal vascular malformation is suspected. If a lesion is found, spinal angiography is considered the criterion standard for optimal analysis of the angioarchitectural features. Embolization with a liquid embolic agent is the first-choice treatment for type 2-4 malformations, whereas surgery may be a better option for type 1 malformations. The prognosis of these lesions seems better than previously thought, especially with advances in endovascular techniques and new embolic agents that offer a high success rate with low morbidity.

Further advances in endovascular and microneurosurgical techniques will be made in the future. Advances in endovascular techniques and equipment should include smaller and more navigable catheters that can be manipulated through tortuous anatomy. The use of noninvasive techniques, such as stereotactic spinal radiosurgery, is presently being investigated.

 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author Jennifer Malone, MD, to the development and writing of this article.



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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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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