1/209. De novo development of a cavernous malformation of the spinal cord following spinal axis radiation. Case report.Analysis of recent reports has suggested that cavernous malformations (CMs) of the brain may have an acquired pathogenesis and a dynamic pathophysiological composition, with documented appearance of new lesions in familial cases and following radiotherapy. The authors report the first case of demonstrated de novo formation of an intramedullary CM following spinal radiation therapy. A 17 year-old boy presented with diabetes insipidus and delayed puberty. Evaluation of endocrine levels revealed hypopituitarism, and magnetic resonance (MR) imaging demonstrated an infundibular mass. The patient underwent a pterional craniotomy and removal of an infundibular germinoma. The MR image of the spine demonstrated normal results. The patient received craniospinal radiation therapy and did well. He presented 5 years later with acute onset of back pain, lower-extremity weakness and numbness, and difficulty with urination. An MR image obtained of the spine revealed an intramedullary T-7 lesion; its signal characteristics were consistent with a CM. The patient was initially managed conservatively but developed progressive myelopathy and partial brown-sequard syndrome. Although he received high-dose steroids and bed rest, his symptoms worsened. He underwent a costotransversectomy and excision of a hemorrhagic vascular lesion via an anterolateral myelotomy. Pathological examination confirmed features of a CM. The patient has done well and was walking without assistance within 4 weeks of surgery. De novo genesis of CMs may be associated with prior radiation therapy to the spinal cord.- - - - - - - - - - ranking = 1keywords = spinal (Clic here for more details about this article) |
2/209. Subdural hematoma from a Type I spinal arteriovenous malformation. Case report.The authors report a patient in whom a subdural hematoma developed from a Type I spinal arteriovenous malformation (AVM). The patient became symptomatic with back pain, and magnetic resonance imaging revealed a spinal subdural hematoma. Selective spinal angiography, however, failed to demonstrate a pathological process. The patient underwent exploratory laminoplasty that revealed a subdural extraarachnoid hematoma with an underlying Type I spinal AVM, which was surgically obliterated. The patient recovered completely. Subdural hematomas that affect the spine are rare. Although a negative result was obtained using selective spinal angiography, exploratory surgery should be considered for the evacuation of a subdural hematoma and possibly for the definitive treatment of a spinal AVM.- - - - - - - - - - ranking = 0.90909090909091keywords = spinal (Clic here for more details about this article) |
3/209. Intraventricular hemorrhage as a false localizing sign of a thoracolumbar arteriovenous malformation: case report.BACKGROUND: Spinal arteriovenous malformation (SAVM) is a relatively rare disease characterized by a high incidence of intramedullary and subarachnoid haemorrhage. When the hemorrhage is profuse and the SAVM is in the cervical region the symptoms (disturbance of consciousness, papilledema, cranial nerve palsies, and convulsions) may be so severe and rapid in their onset that they may be mistaken for intracranial hemorrhage. We report here on a patient with a SAVM at T10-12, which bled intracranially, mainly intraventricularly, and resulted first in respiratory arrest and unconsciousness. CASE DESCRIPTION: The patient had been well until he was 28 years old when, during intercourse, he suffered a terrible headache and suddenly lost consciousness, with a transient respiratory arrest. He was also noted to have right hemiparesis. A computed tomography scan demonstrated intraventricular hemorrhage. After a 24-hour period of artificial ventilation the patient regained consciousness and the right arm paresis completely recovered, but a gradual worsening of the motor function of the left leg developed. Digital subtraction angiography did not demonstrate any intracranial source of bleeding, whereas spinal angiography revealed a SAVM located at the medullary cone, which was totally removed by surgery. CONCLUSION: The case reported here raises several important issues. First, the advisability of spinal magnetic resonance imaging in the investigation of intraventricular (and subarachnoid) hemorrhage in patients with no demonstrable intracranial source. Secondly, the benefits of early diagnosis and reestablishment of the spinal cord circulation before the onset of thrombosis and the progressive phase of myelopathy. Finally, the necessity of complete obliteration and treatment of SAVMs even in patients with fixed neurologic deficits, because rebleeding of lower thoracic or lumbar SAVMs can lead to impairment at a higher level with severe or lethal consequences.- - - - - - - - - - ranking = 0.27272727272727keywords = spinal (Clic here for more details about this article) |
4/209. Surgical management of angiographically occult spinal dural arteriovenous fistulae (type I spinal arteriovenous malformations): three technical case reports.OBJECTIVE AND IMPORTANCE: Spinal dural arteriovenous fistulae (Type I spinal arteriovenous malformations [AVMs]) have been recognized as a treatable cause of progressive myelopathy. The diagnosis and characterization of these lesions rest heavily on spinal angiography. CLINICAL PRESENTATION: We present three patients whose clinical presentations were consistent with a spinal dural AVM but whose spinal angiographic results were negative. INTERVENTION: The surgical treatment of these angiographically occult spinal AVMs is described. In retrospect, in each case, the feeding vessel to the AVM was injected but not seen. CONCLUSION: Some spinal dural arteriovenous fistulae will be angiographically occult. If the clinical and radiographic presentations strongly suggest the presence of an arteriovenous fistula, surgical exploration should be considered.- - - - - - - - - - ranking = 1.2727272727273keywords = spinal (Clic here for more details about this article) |
5/209. Anaesthetic management of a woman who became paraplegic at 22 weeks' gestation after a spontaneous spinal cord haemorrhage secondary to a presumed arteriovenous malformation.A 19-yr-old woman developed a paraplegia with a T10 sensory level at 22 weeks' gestation. The spinal injury was caused by spontaneous bleed of a presumed arteriovenous malformation in the spinal cord. She presented for Caesarean section at term because of the breech position of her fetus. The successful use of a combined spinal epidural-regional anaesthetic is described and the risks of general and regional anaesthesia are discussed.- - - - - - - - - - ranking = 0.63636363636364keywords = spinal (Clic here for more details about this article) |
6/209. Multiple cerebral arteriovenous malformations (AVMs) associated with spinal AVM.The co-existence of multiple cerebral arteriovenous malformations (AVMs) and a spinal AVM is extremely rare. A 22-year-old man suddenly developed severe headache. Computed tomography (CT) scan showed intracerebral haemorrhage in the left occipital lobe. cerebral angiography revealed eight AVMs; four were in the right frontal lobe and two each were in the right temporal and left occipital lobe, respectively. A huge high-flow spinal AVM was found incidentally. He had no other vascular lesions such as hereditary haemorrhagic telangiectasia. A left occipital craniotomy was performed and the ruptured left occipital AVMs were removed. Further therapeutic treatment was refused. To our knowledge, except for one autopsy case, this is the first reported patient with multiple cerebral AVMs with a spinal AVM. We discuss the characteristics of this case and review reported cases with cerebral and spinal AVMs.- - - - - - - - - - ranking = 0.72727272727273keywords = spinal (Clic here for more details about this article) |
7/209. spinal cord arteriovenous malformations in two patients with hereditary hemorrhagic telangiectasia.We report two cases, in first cousins, of spinal arteriovenous malformations (AVMs) of the perimedullary fistula type and hereditary hemorrhagic telangiectasia (HHT). Spinal AVMs are a rare clinical presentation of HHT, but can be the first manifestation in a child with this disorder. The importance of considering a coexisting disorder of vascular dysplasia, such as HHT, when a child presents with a spinal AVM is discussed.- - - - - - - - - - ranking = 0.18181818181818keywords = spinal (Clic here for more details about this article) |
8/209. Arteriovenous and lymphatic malformations, linear verrucous epidermal nevus and mild overgrowth: another hamartoneoplastic syndrome?We report a 22 year old female presenting with slowly progressive paraparesis, who appeared to have many (mainly subcutaneous) hamartomas. The neurological symptoms were caused by intraspinal masses and arteriovenous malformations. In addition, she had mild overgrowth of one leg and lymph vessel malformations. This combination of symptoms resembles proteus syndrome, but is different in symptomatology and progression and may be yet another hamartoneoplastic syndrome.- - - - - - - - - - ranking = 0.090909090909091keywords = spinal (Clic here for more details about this article) |
9/209. rupture of a cervical spinal cord arteriovenous malformation: a rare complication of endovascular embolization.patients suffering from a cervical spinal cord arteriovenous malformation (SCAVM) run high risk of devastating subarachnoid hemorrhage and hematomyelia. Therefore, cervical SCAVMs represent a compelling indication for surgical or endovascular therapy. The authors report on an acute life-threatening subarachnoid hemorrhage from a cervical SCAVM that ruptured during an embolization procedure. causality and therapeutic management are discussed.- - - - - - - - - - ranking = 0.45454545454545keywords = spinal (Clic here for more details about this article) |
10/209. Multiple gigantic arteriovenous malformations with destruction of lumbar vertebral bodies. A case report.STUDY DESIGN: This case report describes a patient with massive intramuscular and paravertebral arteriovenous malformations with destruction of vertebral bodies. OBJECTIVES: To demonstrate successful interbody fusion of the involved vertebral bodies after embolization for arteriovenous malformation. SUMMARY OF BACKGROUND DATA: Although arteriovenous malformations in the spinal cord are well documented in the literature, arteriovenous malformation in the paravertebral and iliopsoas muscles with destruction of vertebral bodies is an extremely rare clinical condition. methods: After careful investigation with angiography, the arteriovenous malformations were managed with embolization, and the scoliosis caused by the collapsed vertebral bodies was managed surgically by anterior spinal fusion with segmental spinal instrumentation. RESULTS: The patient's scoliosis caused by vertebral collapse was corrected by surgery, and good alignment of the lumbar spine was achieved. The preoperation pain had subsided completely by follow-up assessment 1 year and 10 months after fusion. However, the arteriovenous malformations still remained. Careful observation should be maintained continuously in the coming days. CONCLUSION: In arteriovenous malformations with destruction of the vertebral bodies, embolization and spinal fusion with segmental instrumentation may be necessary to relieve pain and prevent the progression of spinal deformity. Arteriovenous malformation should be considered in the diagnostic evaluation of a patient who has experienced vertebral collapse with no inflammatory signs.- - - - - - - - - - ranking = 0.45454545454545keywords = spinal (Clic here for more details about this article) |
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