Abstract
Spinal vascular pathologies are rare diseases that can lead to devastating outcomes. However, early diagnosis and treatment can be life-changing for the patient. While ischemia and hemorrhage present with acute onset symptoms, vascular malformations show insidious and progressive deterioration. Cavernous malformations may exhibit episodic symptoms. Therefore, detailing clinical findings, taking an appropriate medical history, and accurately evaluating imaging findings are essential for correct diagnosis. Although magnetic resonans imaging (MRI) is the primary imaging modality for diagnosis, diffusion-weighted imaging should be added if ischemia is suspected, and MR or computed tomography angiography should be included if aneurysm or vascular malformation is suspected. Especially in vascular malformations, spinal angiography is the gold standard for diagnosis and treatment. Endovascular methods are the first-line treatment options for these pathologies.
Keywords: Spinal cord ischemia, spinal hemorrhage, aneurysm, vascular malformation
References
Becske T, Nelson PK. The vascular anatomy of the vertebro-spinal axis.Neurosurg Clin N Am. 2009; 20: 259-64.
Santillan A, Nacarino V, Greenberg E, Riina HA, Gobin YP, Patsalides A. Vascular anatomy of the spinal cord.J Neurointerv Surg. 2012; 4: 67-74.
Taterra D, Skinningsrud B, Pękala PA, Hsieh WC, Cirocchi R, Walocha JA, et al. Artery of Adamkiewicz: a meta-analysis of anatomical characteristics.Neuroradiology. 2019; 61: 869-80.
Hong MK, Hong MK, Pan WR, Wallace D, Ashton MW, Taylor GI. The angiosome territories of the spinal cord: exploring the issue of preoperative spinal angiography. Laboratory investigation.J Neurosurg Spine. 2008; 8: 352-64.
Thron AK. Vascular anatomy of the spinal cord: neuroradiological investigations and clinical syndromes.Springer Science & Business Media.1988.
Kramer CL. Vascular disorders of the spinal cord.Continuum (Minneap Minn). 2018; 24 (2, Spinal Cord Disorders): 407-26.
Griessenauer CJ, Raborn J, Foreman P, Shoja MM, Loukas M, Tubbs RS. Venous drainage of the spine and spinal cord: a comprehensive review of its history, embryology, anatomy, physiology, and pathology.Clin Anat.2015; 28: 75-87.
Gailloud P. Introduction to diagnostic and therapeutic spinal angiography.Neuroimaging Clin N Am. 2019; 29: 595-614.
Da Ros V, Picchi E, Ferrazzoli V, Schirinzi T, Sabuzi F, Grillo P, et al. Spinal vascular lesions: anatomy, imaging techniques and treatment.Eur J Radiol Open. 2021; 8: 100369.
Weidauer S, Nichtweiß M, Hattingen E, Berkefeld J. Spinal cord ischemia: aetiology, clinical syndromes and imaging features.Neuroradiology. 2015; 57: 241-57.
Weidauer S, Wagner M, Nichtweiß M. Magnetic resonance ımaging and clinical features in acute and subacute myelopathies.Clin Neuroradiol. 2017; 27: 417-33.
Vargas MI, Gariani J, Sztajzel R, Barnaure-Nachbar I, Delattre BM, Lovblad KO, et al. Spinal cord ischemia: practical imaging tips, pearls, and pitfalls.AJNR Am J Neuroradiol. 2015; 36: 825-30.
Vuong SM, Jeong WJ, Morales H, Abruzzo TA. Vascular diseases of the spinal cord: ınfarction, hemorrhage, and venous congestive myelopathy.Semin Ultrasound CT MR. 2016; 37: 466-81.
Yadav N, Pendharkar H, Kulkarni GB. Spinal cord ınfarction: clinical and radiological features.J Stroke Cerebrovasc Dis. ; 27: 2810-21.
Kranz PG, Amrhein TJ. Imaging approach to myelopathy: acute, subacute, and chronic.Radiol Clin North Am. 2019; 57: 257-79.
Kreppel D, Antoniadis G, Seeling W. Spinal hematoma: a literature survey with meta-analysis of 613 patients.Neurosurg Rev. 2003; 26: 1-49.
Pierce JL, Donahue JH, Nacey NC, Quirk CR, Perry MT, Faulconer N, et al. Spinal hematomas: what a radiologist needs to know.Radiographics. ; 38: 1516-35.
Domenicucci M, Mancarella C, Santoro G, Dugoni DE, Ramieri A, Arezzo MF, et al. Spinal epidural hematomas: personal experience and literature review of more than 1000 cases.J Neurosurg Spine. 2017; 27: 198-208.
Moriarty HK, O Cearbhaill R, Moriarty PD, Stanley E, Lawler LP, Kavanagh EC. MR imaging of spinal haematoma: a pictorial review.Br J Radiol. 2019; 92: 20180532.
Shaban A, Moritani T, Al Kasab S, Sheharyar A, Limaye KS, Adams HP Jr. Spinal cord hemorrhage.J Stroke Cerebrovasc Dis. ; 27: 1435-46.
de Beer MH, Eysink Smeets MM, Koppen H. Spontaneous spinal subdural hematoma.Neurologist. 2017; 22: 34-9.
Honda S, Fujibayashi S, Onishi E, Odate S, Tamaki Y, Tomizawa T, et al. Acute non-traumatic spinal subarachnoid hematomas: a report of five cases and a systematic review of literature.J Orthop Sci. ; 28: 966-71.
Crossley RA, Raza A, Adams WM. The lumbar sedimentation sign: spinal MRI findings in patients with subarachnoid haemorrhage with no demonstrable intracranial aneurysm.Br J Radiol. 2011; 84: 279-81.
Domenicucci M, Ramieri A, Paolini S, Russo N, Occhiogrosso G, Di Biasi C, et al. Spinal subarachnoid hematomas: our experience and literature review.Acta Neurochir (Wien). 2005; 147: 741-50.
Leep Hunderfund AN, Wijdicks EF. Intramedullary spinal cord hemorrhage (hematomyelia).Rev Neurol Dis. 2009; 6: 54-61.
Shah LM, Flanders AE. Update on new ıimaging techniques for trauma.Neurosurg Clin N Am. 2017; 28: 1-21.
Leypold BG, Flanders AE, Burns AS. The early evolution of spinal cord lesions on MR imaging following traumatic spinal cord injury.AJNR Am J Neuroradiol. 2008; 29: 1012-6.
Alomari S, Xu R, Huang J, Tamargo R, Bydon A. Isolated aneurysms of the spinal circulation: a systematic review of the literature.Neurosurg Rev. 2022; 45: 989-1008.
Abdalkader M, Samuelsen BT, Moore JM, Cervantes-Arslanian A, Ong CJ, Setty BN, et al. Ruptured spinal aneurysms: diagnosis and management paradigms.World Neurosurg. 2021; 146: 368-77.
Madhugiri VS, Ambekar S, Roopesh Kumar VR, Sasidharan GM, Nanda A. Spinal aneurysms: clinicoradiological features and management paradigms.J Neurosurg Spine. 2013; 19: 34-48.
Renieri L, Raz E, Lanzino G, Krings T, Shapiro M, Shirani P, et al. Spinal artery aneurysms: clinical presentation, radiological findings and outcome.J Neurointerventional Surg. 2018; 10: 644-8.
Koutsothanasis GA, Sampath R. Berry aneurysm. In:StatPearls. StatPearls Publishing; 2024. Accessed May 12, 2024.
Son S, Lee SG, Park CW. Solitary ruptured aneurysm of the spinal artery of adamkiewicz with subarachnoid hemorrhage.J Korean Neurosurg Soc. 2013; 54: 50-3.
Gutierrez Romero D, Batista AL, Gentric JC, Raymond J, Roy D, Weill A. Ruptured isolated spinal artery aneurysms. Report of two cases and review of the literature.Interv Neuroradiol. ; 20: 774-80.
Maiti TK, Bir SC, Nanda A. Spinal subarachnoid hemorrhage and aneurysms.Handb Clin Neurol. 2017;143:215-23.
Ikeda S, Takai K, Kikkawa Y, Takeda R, Ikeda T, Kohyama S, et al. Ruptured posterior spinal artery aneurysm: intraoperative and histologic findings with appreciable thrombosis.Spine J.2016; 16: 215-7.
Endo T, Endo H, Sato K, Matsumoto Y, Tominaga T. Surgical and endovascular treatment for spinal arteriovenous malformations.Neurol Med Chir (Tokyo). 2016; 56: 457-64.
Flores BC, Klinger DR, White JA, Batjer HH. Spinal vascular malformations: treatment strategies and outcome.Neurosurg Rev. 2017; 40: 15-28.
Lizana J, Aliaga N, Marani W, Escribano A, Montemurro N. Spinal vascular shunts: single-center series and review of the literature of their classification.Neurol Int. 2022; 14: 581-99.
Takai K. Spinal arteriovenous shunts: angioarchitecture and historical changes in classification.Neurol Med Chir (Tokyo). 2017; 57: 356-65.
Koch C. Spinal dural arteriovenous fistula.Curr Opin Neurol. 2006; 19: 69-75.
Maimon S, Luckman Y, Strauss I. Spinal dural arteriovenous fistula: a review.Adv Tech Stand Neurosurg. 2016: 111-37.
Gross BA, Du R. Spinal glomus (type II) arteriovenous malformations: a pooled analysis of hemorrhage risk and results of intervention.Neurosurgery. 2013; 72: 25-32.
Patsalides A, Knopman J, Santillan A, Tsiouris AJ, Riina H, Gobin YP. Endovascular treatment of spinal arteriovenous lesions: beyond the dural fistula.AJNR Am J Neuroradiol. 2011; 32: 798-808.
Zhang HQ, Chen T, Wu SS, Teng LH, Li YZ, Sun LY, et al. The pathophysiology of venous hypertensive myelopathy--study of an animal model: laboratory investigation.J Neurosurg Spine. 2013; 19: 485-91.
Jellema K, Tijssen CC, van Gijn J. Spinal dural arteriovenous fistulas: a congestive myelopathy that initially mimics a peripheral nerve disorder.Brain J Neurol. 2006; 129: 3150-64.
Alkhaibary A, Alharbi A, Alnefaie N, Alammar H, Arishy AM, Alghanim N, et al. Spinal dural arteriovenous fistula: a comprehensive review of the history, classification systems, management, and prognosis.Chin Neurosurg J. 2024; 10: 2.
Abecassis IJ, Osbun JW, Kim L. Classification and pathophysiology of spinal vascular malformations.Handb Clin Neurol. 2017; 143: 135-43.
Kona MP, Buch K, Singh J, Rohatgi S. Spinal vascular shunts: a patterned approach.AJNR Am J Neuroradiol. 2021; 42: 2110-8.
Brinjikji W, Lanzino G. Endovascular treatment of spinal arteriovenous malformations.Handb Clin Neurol. 2017; 143: 161-74.
Krings T, Mull M, Gilsbach JM, Thron A. Spinal vascular malformations.Eur Radiol. 2005; 15: 267-78.
P Phadke RV, Bhattacharyya A, Handique A, Jain K, Kumar A, Singh V, et al. Endovascular treatment in spinal perimedullary arteriovenous fistula.Interv Neuroradiol. 2014; 20: 357-67.
Takai K, Taniguchi M. Comparative analysis of spinal extradural arteriovenous fistulas with or without intradural venous drainage: a systematic literature review.Neurosurg Focus. 2012; 32: 8.
Rangel-Castilla L, Holman PJ, Krishna C, Trask TW, Klucznik RP, Diaz OM. Spinal extradural arteriovenous fistulas: a clinical and radiological description of different types and their novel treatment with Onyx.J Neurosurg Spine. 2011; 15: 541-9.
Donghai W, Ning Y, Peng Z, Shuo X, Xueen L, Peng Z, et al. The diagnosis of spinal dural arteriovenous fistulas.Spine. 2013; 38: 546-53.
Krings T, Geibprasert S. Spinal dural arteriovenous fistulas.AJNR Am J Neuroradiol. 2009; 30: 639-48.
Do-Dai DD, Brooks MK, Goldkamp A, Erbay S, Bhadelia RA. Magnetic resonance imaging of intramedullary spinal cord lesions: a pictorial review.Curr Probl Diagn Radiol. 2010; 39: 160-85.
Mathur S, Bharatha A, Huynh TJ, Aviv RI, Symons SP. Comparison of time-resolved and first-pass contrast-enhanced mr angiography in pretherapeutic evaluation of spinal dural arteriovenous fistulas.AJNR Am J Neuroradiol. 2017; 38: 206-12.
Akgun MY, Kemerdere R, Ulu MO, Alizada O, Isler C, Kizilkilic O, et al. Spinal vascular malformations: treatment and outcome.World Neurosurg. 2019; 130: 953-60.
Badhiwala JH, Farrokhyar F, Alhazzani W, Yarascavitch B, Aref M, Algird A, et al. Surgical outcomes and natural history of intramedullary spinal cord cavernous malformations: a single-center series and meta-analysis of individual patient data: clinic article.J Neurosurg Spine. 2014; 21: 662-76.
Lu DC, Lawton MT. Clinical presentation and surgical management of intramedullary spinal cord cavernous malformations.Neurosurg Focus. 2010; 29: 12.
Clark AJ, Wang DD, Lawton MT. Spinal cavernous malformations.Handb Clin Neurol. 2017; 143: 303-8.
Izi Z, El Haddad S, Allali N, Chat L. Spinal cord cavernous malformation: a case report.Glob Pediatr Health. 2023; 10: 2333794X231184317.
Otten M, Mccormick P. Natural history of spinal cavernous malformations.Handb Clin Neurol. 2017; 143: 233-9.
Vilanova JC, Barceló J, Smirniotopoulos JG, Pérez-Andrés R, Villalón M, Miró J, et al. Hemangioma from head to toe: MR imaging with pathologic correlation.Radiographics. ; 24: 367-85.
Liao D, Wang R, Shan B, Chen H. Surgical outcomes of spinal cavernous malformations: a retrospective study of 98 patients.Front Surg. 2022; 9: 1075276.


