Spinal Arteriovenous Shunts:Which are Curable and which Incurable?

概要

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The spinal cord is supplied mainly by an anterior spinal artery with small branches named the sulcal arteries and superficially by the posterior spinal arteries. The spinal cord arterial network has a simple structure with these vessels and connecting vessels such as the vasa corona on the surface of the spinal cord and the arterial basket at the conus medullaris. Spinal angiography under general anesthesia helps to understand this vascular anatomy. Spinal dural arteriovenous fistula (AVF) presents with spinal cord symptoms due to venous hypertension, and can be treated by embolization or surgery. Spinal cord arteriovenous malformation (AVM) presents with pain or bleeding. Perimedullary AVF and filum terminale AVM can be treated by embolization or surgery. However, intramedullary AVM is difficult to be cured. AVF at craniocervical junction including perimedullary and dural AVF may present with subarachnoid hemorrhage or spinal cord symptom, and can be treated mainly by surgery.