Learning objectives
To know the vascular anatomy of the spine.
To propose a simplified algorithm for radiological diagnosis,
based on Kim and Spetzler's classification of spinal arteriovenous lesions.
Exemplify the different spinal arteriovenous lesions with radiological cases.
Background
Spinal arteriovenous (AV) lesions are a group of diverse and infrequent entities (5-10 cases / million),
characterized by an abnormal communication between arteries and veins in the spine.
The understanding of their physiopathology has evolved gradually along years,
resulting in different classifications and nomenclatures.
One scheme divides spinal AV lessions according to their feeding artery in meningeal and pial lessions.
This classification may be useful,
however,
we believe that it is difficult to apply in daily practice of neuroradiological diagnosis.
Other nomenclature,
based in physiopathology...
Findings and procedure details
VASCULAR ANATOMY
Arteries:
Each segment of the spine (metamere) is supplied by paired segmental arteries (left and right) that feed all its components,
including the vertebral body,
paraspinal muscles,
dura,
nerves roots and spinal cord.
Those segmental arteries have multiple longitudinal and transverse connections at different levels,
configuring two network anastomoses: a extraspinal and intraspinal-extradural system (Fig. 1,
Fig. 2).
The segmental artery gives a dorsal branch,
the dorsal spinal artery.This artery irrigates the posterior elements,
giving a dorsal branch and a ventral branch.The dorsal...
Conclusion
To better understand the spinal AV lesions is necessary to know the normal vascular anatomy,
as well as their physiopathological mechanisms.
The use of a simplified algorithm based on the presence or absence of vascular nidus,
in addition to its anatomic location,
maybe useful in the radiological diagnosis of the spinal AV lesions.
Personal information
Department of Radiology,
Universidad de Chile.
Marcelo López MD,
MSc
[email protected]
References
Spetzler RF,
Detwiler PW,
Riina HA,
Porter RW.
Modified classification of spinal cord vascular lesions.
J Neurosurg 2002; 96:145–156.
Kim LJ,
Spetzler RF.
Classification and surgical management of spinal arteriovenous lesions: arteriovenous fistulae and arteriovenous malformations.
Neurosurgery 2006; 59:S3-195-S3-201.
Krings T.
Vascular malformations of the spine and spinal cord: anatomy,
classification,
treatment.
Clin Neuroradiol 2010; 20: 5–24.
Rubin MN,
Rabinstein AA: Vascular Diseases of the Spinal Cord.
Neurol Clin 2013; 31: 153–181.
Marcus J,
Schwarz J,
Singh P,
Sigounas D,
Knopman J,
Gobin YP,
Patsalides....