Spinal Dural AVF
Indications
The presence of spinal dural AVF is an indication for treatment in all patients; embolization maybe contraindicated in those patients in whom the anterior spinal artery originates from the same pedicle as the spinal dural AVF.
Efficacy
Indicators:
The indicators of the efficacy of the endovascular management are technical and clinical success. Technical success is defined as occlusion of the targeted vessels. Clinical success is obliteration of the vascular malformation definitively or adjunctively or improvement or stabilization of symptoms.
 |
Safety
Indicators:
When the following complications and corresponding thresholds are exceeded, a review should be conducted.
 |
Spinal Cord AVMs
Indications
The indications for embolization of spinal cord AVMs include all symptomatic patients with lesions that can be cured; adjuvant therapy before surgery/radiosurgery; and palliative therapy when total obliteration is not practical and the patient suffers from progressive neurologic deficit or high risk of hemorrhage (associated aneurysm or pseudoaneurysm, previous hemorrhage) or when partial embolization is thought to be of benefit (presence of AVF, outflow restriction with venous ectasia).
Efficacy
Indicators:
The indicators of the efficacy of the endovascular management are technical and clinical success. Technical success is defined as occlusion of the targeted vessels. Clinical success is obliteration of the vascular malformation definitively or adjunctively or improvement or stabilization of symptoms.
 |
Safety
Indicators:
When the following complications and corresponding thresholds are exceeded, a review should be conducted.
 |
Perimedullary AVFs
Indications
The presence of a perimedullary AVF, even if clinically silent, is an indication for treatment. Embolization is indicated if sufficiently superselective catheterization can be performed; surgery may be the best therapeutic modality in cases of type 1 (smallest) perimedullary AVF.
Efficacy
Indicators:
The indicators of the efficacy of the endovascular management are technical and clinical success. Technical success is defined as occlusion of the targeted vessels. Clinical success is obliteration of the vascular malformation definitively or adjunctively or improvement or stabilization of symptoms.
 |
Safety
Indicators:
When the following complications and corresponding thresholds are exceeded, a review should be conducted.
 |
Epidural and Perispinal Vascular Malformations
Indications
Indications include adjunctive (preoperative) and/or palliative treatment when the patient suffers from neurologic or cardiac symptoms.
Efficacy
Indicators:
The indicators of the efficacy of the endovascular management are technical and clinical success. Technical success is defined as occlusion of the targeted vessels. Clinical success is obliteration of the vascular malformation definitively or adjunctively or improvement or stabilization of symptoms.
 |
Safety
Indicators:
When the following complications and corresponding thresholds are exceeded, a review should be conducted.
 |
Spinal Axis Tumor Embolization
Indications
The indications for embolization of hypervascular tumors of the spinal axis include decreasing surgical morbidity by reducing blood loss, shortening operative time, increasing the chance of complete resection, relieving intractable pain, reducing expected tumor recurrence, decreasing systemic toxicity of intra-arterial chemotherapy, stabilization of function, and sole treatment for a patient who is at poor risk for surgical therapy, radiation therapy, and/or chemotherapy.
The hypervascular tumor types for which embolization may be indicated include benign tumors (hemangiomas, aneurysmal bone cysts, osteoid osteomas, osteoblastomas, chondromas), malignant tumors (giant cell tumors, chordomas, osteogenic sarcomas, chondrosarcomas, hemangiopericytomas, lymphomas, multiple myelomas, plasmacytomas), metastatic tumors (renal cell carcinomas, thyroid carcinomas, other hypervascular metastases), and spinal cord tumors (hemangioblastomas).
Threshold:
When <95% of the procedures are performed for the above indication, a review should be conducted.
Efficacy
Indicators:
The indicators of the efficacy of the endovascular management are technical and clinical success. Technical success is defined as occlusion of the targeted vessels. Clinical success is decrease in expected blood loss during surgery or palliation of symptoms.
 |
Safety
Indicators:
When the following complications and corresponding thresholds are exceeded, a review should be conducted.
 |
Puncture site complications, allergic reactions to contrast media, and contrast media-induced nephropathy will be recorded in the angiography section.
Bibliography
- Berenstein A, Lasjaunias P, Spine and spinal cord vascular lesions. In: Surgical Neuroangiography: Endovascular Treatment of Spine and Spinal Cord Lesions. Berlin: Springer-Verlag; 1992:1–109
- Berenstein A, Lasjaunias P, Tumors of the spinal column and spinal cord. In: Surgical Neuroangiography: Endovascular Treatment of Spine and Spinal Cord Lesions. Berlin: Springer-Verlag; 1992:111–147
- Biondi A, Merland JJ, Reizine D, Embolization with particles in thoracic intramedullary arteriovenous malformations: long-term angiographic and clinical results. Radiology 1990;177:651-658 [DOI] [PubMed] [Google Scholar]
- Casasco AE, Houdart E, Gobin YP, Aymard A, Guichard JP, Rufenacht DA, Embolization of spinal vascular malformations. Neuroimaging Clin N Am 1992;2:337-358 [Google Scholar]
- Choi IS, Berenstein A, Surgical neuroangiography of the spine and spinal cord. Radiol Clin North Am 1988;26:1131-1141 [PubMed] [Google Scholar]
- Djindjian M, Djindjian R, Rey A, Hurth M, Houdart R, Intradural extramedullary spinal arterio-venous malformations fed by the anterior spinal artery. Surg Neurol 1977;8:85-93 [PubMed] [Google Scholar]
- Halbach VV, Higashida RT, Dowd CF, Fraser KW, Edwards MS, Barnwell SL, Treatment of giant intradural (perimedullary) arteriovenous fistulas. Neurosurgery 1993;33:972-980 [DOI] [PubMed] [Google Scholar]
- Merland JJ, Reizine D, Treatment of arteriovenous spinal cord malformations. Semin Intervent Radiol 1987;4:281-290 [Google Scholar]
- Merland JJ, Reizine D, Laurent A, Khayata MH, Casasco A, Aymard A, Gobin YP, Embolization of spinal cord vascular lesions. In: Viñuela F, Halbach VV, Dion JE, eds. Interventional Neuroradiology: Endovascular Therapy of the Central Nervous System New York: Raven Press; 1992:153–165
- Merland JJ, Riche MC, Chiras J, Intraspinal extramedullary arteriovenous fistulae draining into the medullary veins. J Neuroradiol 1980;7:271-320 [PubMed] [Google Scholar]
- Mourier KL, Gobin YP, George B, Lot G, Merland JJ, Intradural perimedullary arteriovenous fistulae: results of surgical and endovascular treatment in a series of 35 cases. Neurosurgery 1993;32:885-891 [DOI] [PubMed] [Google Scholar]
- Niimi Y, Sala F, Deletis F, Berenstein A, Provacative testing for embolization of spinal cord AVMs. Intervent Neuroradiol 2000;6: suppl 1:191-194 [DOI] [PMC free article] [PubMed] [Google Scholar]
- Olerud C, Jonsson H Jr, Lofberg AM, Lorelius LE, Sjostrom L, Embolization of spinal metastases reduces preoperative blood loss: 21 patients operated on for renal cell carcinoma. Acta Orthop Scand 1993;64:9-12 [DOI] [PubMed] [Google Scholar]
- Rodesch G, Hurth M, Embolization of spinal cord arteriovenous malformations with glue through the anterior spinal axis. Intervent Neuroradiol 1997;3:131-143 [DOI] [PubMed] [Google Scholar]
- Smith TP, Koci T, Mehringer CM, Transarterial embolization of vertebral hemangioma. J Vasc Interv Radiol 1993;4:681-685 [DOI] [PubMed] [Google Scholar]
- Ushikoshi S, Hida K, Kikuchi K, Iwasaki y, Miyasaka K, Abe H, Treatment of intramedullary arteriovenous malformations of the spinal cord. Intervent Neuroradiol 2000;6: suppl 1:203-207 [DOI] [PMC free article] [PubMed] [Google Scholar]