脊髄動静脈奇形に対する血管内手術  [in Japanese] Embolization of Spinal Arteriovenous Malformations  [in Japanese]

Based upon the recent improvement of microsurgical anatomy of the spinal cord, image diagnoses, techniques and materials of intrventional neuroradiology, and microsurgical techniques, there has been remarkable progress in the treatment of spinal arteriovenous marformations. They are classified into three types; namely, intramedullary arteriovenous marformation (AVM), perimedullary arteriovenous fistula (AVF), and spinal dural arteriovenous fistula (DAVF). In this presentation, we are going to present our policy, tactics and techniques of endovascular treatment of three types of spinal arteriovenous marformations. 1) Intramedullary arteriovenous malformation : Complete cure of intramedullary AVM is difficult, because of the participation of perforating arteries. Recommended treatment is the flow directed embolization using polyvinyl alcohol particles. This treatment has been accepted as a measure to put the malformation under control and revert the neurological derangement related to edema. 2) Perimedullary arteriovenous fistula : A subdivision into tree types of perimedullay AVFs was proposed by Merland, et al. Type 1 AVFs are difficult to embolize. Surgical treatment is the primary consideration for this type. Type 2 and 3 AVFs are amenable to embolization. Combined embolization using n-butyl-2-cyanoacrylate (NBCA) and microsurgery is the primary consideration for these types. 3) Spinal dural arteriovenous fistula : Spinal DAVF is the most common type of spinal AVM besides genuine spinal AVM. Embolization using NBCA is preferred to microsurgery to interrupt the shunt in most of the cases with spinal DAVF because of its efficacy, safety and less invasiveness.