Endovascular Management of Spinal Vascular Malformations

What are Spinal Vascular Malformations? 

A Spinal Vascular Malformation (SVM) is a rare, abnormal tangle of blood vessels, leading to incorrect connections between arteries and veins in or near the spinal cord. Deprived of oxygen, this may cause your spinal tissue to deteriorate or die. Thus, SVMs, if left untreated, can leave permanent damage on your spinal cord. 

Over time, SVMs may grow in size due to the increase in blood flow. In some cases, this may cause the walls of the blood vessels to weaken and burst, resulting in bleeding in the spinal cord, also known as a hemmorage. In other cases, the increase in size of the SVM may compress on the spinal cord, resulting in a condition known as myelopathy. 

There are two ways in which SVMs can be treated – embolization and surgery. 

What happens during an embolization?

An embolization refers to a minimally invasive procedure, whereby problematic blood vessels are blocked off and blood flow to the blood vessel is cut off. An embolisation can be used to treat a SVM.

During a SVM embolization, your surgeon will guide a soft hollow tube, known as a catheter, through your femoral artery in your leg, up your blood vessels and until the tip of the catheter reaches your SVM. Your surgeon will then inject a substance into your SVM which will create an artificial clot. This will stop the blood from flowing into the SVM. This process is then repeated for every vessel that leads to the SVM. 

A SVM embolization is usually conducted with X-ray guidance. This procedure is typically performed with the patient under general anesthesia. Under general anesthesia, you will be put into a sleep-like state, and you will not be able to move voluntarily or feel any pain.  

What are the benefits of embolization as compared to surgery? 

Some of the benefits of brain SVM embolization include: 

  • Relatively high success rate
  • No open surgery 
  • Lower risk of complications 
  • Low procedure-related mortality rate 

What are some possible complications of embolization?

Some possible complications of embolization include: 

  • Damage to artery where catheter was inserted
  • Risk of infection at site where catheter was inserted or spinal cord 
  • Injury/ bruising of spinal cord 
  • Anesthetic related complications
  • Death 

What happens during surgery? 

SVMs can be treated surgically if the SVM is located in a place where it is easily operable. The type of surgery depends on the locatino of your SVM. The most common surgery types include surgical ligation, wherey the problem blood vessel is tied off, and resection of the SVM, whereby the whole SVM is surgically removed. In certain cases, spinal radiation may be used as well. 

Similar to embolization, surgery is usually performed with the patient under general anesthesia. 

What are some possible complications of surgery?

Some possible complications of surgery include: 

  • Risk of infection at surgical site or spinal cord 
  • Injury/ bruising of spinal cord 
  • Anesthetic related complications
  • Death 

What happens after SVM treatment?

After treatment, you will likely spend a few hours in the recovery room, and at the hospital for a day or more depending on your condition. Your doctor will also watch your vital signs, such as your heart rate and breathing to ensure that you are recovering well after your procedure. 

Your doctor will likely ask you to return to the clinic a few months after your procedure. Your doctor may order a follow-up angiogram or MRI scan to see if there are any remaining parts of the SVM. This will determine if any additional embolization or surgery is needed. 

If you have any questions about the types of SVM treatments, do seek clarification with your doctor and find out which treatment is suitable for you.

References
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  1. Flores, B. C., Klinger, D. R., White, J. A., & Batjer, H. H. (2017). Spinal vascular malformations: treatment strategies and outcome. Neurosurgical Review, 40(1), 15–28. https://doi.org/10.1007/s10143-016-0713-z
  2. S Harrop, J. (2019). Vascular Malformations of the Spinal Cord Treatment & Management: Medical Therapy, Surgical Therapy, Preoperative Details. EMedicine. https://emedicine.medscape.com/article/248456-treatment#d10 
  3. Singh, B., Behari, S., Jaiswal, A. K., Sahu, R. N., Mehrotra, A., Mohan, B. M., & Phadke, R. V. (2016). Spinal arteriovenous malformations: Is surgery indicated? Asian Journal of Neurosurgery, 11(2), 134–142. https://doi.org/10.4103/1793-5482.177663
  4. Spinal Vascular Malformations. (2020). Baylor College of Medicine. https://www.bcm.edu/healthcare/specialties/neurosurgery/cerebrovascular-and-stroke-surgery/spinal-vascular-malformations