Spinal Cord Vascular Diseases

Spinal vascular malformations include various entities, including spinal dural arteriovenous (AV) fistulas, acquired malformations and cavernous hemangiomas, and spinal arteriovenous malformations. AV fistula refers to a spinal cord vascular malformation in which there is a short-circuit connection between a dural artery and a perimedullary vein superficial to the myelon. The condition is relatively rare, initial clinical symptoms are often misinterpreted, and a definitive diagnosis is often delayed by 12 months or more. However, early diagnosis is important to prevent progression of clinical symptoms, which may include paraplegia. Early magnetic resonance imaging (MRI) is helpful, showing intramedullary edema in the T2-weighted sequences and superficial, markedly dilated veins. Treatment consists of ligation of the AV fistula, either surgically or by embolization. Cavernous hemangiomas, consisting of a large number of closely located immature blood vessels, are also relatively rare and have a low risk of bleeding (approximately 0.2-0.5%). Venous hemorrhage may also occur, resulting in clinical symptoms (including paraplegia).