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Management of spinal aneurysms associated with arteriovenous malformations: systematic literature review and illustrative case

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Abstract

Purpose

Spinal aneurysms are rare vascular malformations, commonly associated with spinal AVMs. AVM-associated spinal aneurysms are burdened by significant morbidity. The purpose of our study is to evaluate the best treatment strategy for these uncommon vascular lesions and to report an illustrative case.

Methods

We reviewed clinical and radiological data of a patient surgically treated at our institution for a spinal AVM with an associated prenidal aneurysm. According to PRISMA guidelines, a systematic literature review has been performed in order to discuss the best management AVM-associated prenidal aneurysms.

Results

In the reported case, the aneurysm showed spontaneous regression at follow-up after surgical removal of the AVM. Only 6 articles reported management of spinal prenidal AVM-associated aneurysms. Basing on our experience and data from literature, surgical treatment of the aneurysm may be indicated along with the resection of the AVM if the aneurysm is close to the nidus. Conversely, if the aneurysm is far away from the nidus or in an unfavorable position, resection of the nidus only may lead to aneurysm regression as in the reported case.

Conclusions

The treatment strategy for AVM-associated spinal aneurysms should be tailored on the single patient. In presence of large aneurysms that cause mass-effect symptoms, when rupture of the aneurysm is suspected or when treatment of the AVM is not proposable, direct treatment of the aneurysm should be considered. Otherwise, when complete resection of the nidus is performed, the eventually associated unruptured aneurysms located in challenging positions can be safely managed conservatively.

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Availability of data and material

Clinical and radiological data are available upon specific request to the corresponding author.

References

  1. Geibprasert S, Krings T, Apitzsoh J et al (2010) Subarachnoid hemorrhage following posterior spinal artery aneurysm: a case report and review of the literature. Interv Neuroradiol 16:183–190. https://doi.org/10.1177/159101991001600211

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Madhugiri VS, Ambekar S, Roopesh Kumar VR et al (2013) Spinal aneurysms: clinicoradiological features and management paradigms. A systematic review. J Neurosurg Spine 19:34–48. https://doi.org/10.3171/2013.3.SPINE121026

    Article  PubMed  Google Scholar 

  3. Renieri L, Raz E, Lanzino G et al (2018) Spinal artery aneurysms: clinical presentation, radiological findings and outcome. J Neurointerv Surg 10:646–650. https://doi.org/10.1136/neurintsurg-2017-013687

    Article  Google Scholar 

  4. Walz DM, Woldenberg RF, Setton A (2006) Pseudoaneurysm of the anterior spinal artery in a patient with moyamoya: an unusual cause of subarachnoid hemorrhage. Am J Neuroradiol 27:1576–1578

    CAS  PubMed  PubMed Central  Google Scholar 

  5. Rengachary SS, Duke DA, Tsai FY, Kragel PJ (1993) Spinal arterial aneurysm: case report. Neurosurgery 33:125–130. https://doi.org/10.1227/00006123-199307000-00020

    Article  CAS  PubMed  Google Scholar 

  6. Spetzler RF, Detwiler PW, Riina HA, Porter RW (2002) Modified classification of spinal cord vascular lesions. J Neurosurg 96:145–156. https://doi.org/10.3171/spi.2002.96.2.0145

    Article  PubMed  Google Scholar 

  7. Jung SC, Song Y, Cho SH et al (2018) Endovascular management of aneurysms associated with spinal arteriovenous malformations. J Neurointerv Surg 10:198–203. https://doi.org/10.1136/neurintsurg-2017-013150

    Article  PubMed  Google Scholar 

  8. Medical Research Council (1943) Aids to the investigation of the peripheral nervous system. Her Majesty’s Stationary Office, London

  9. Kim LJ, Spetzler RF (2006) Classification and surgical management of spinal arteriovenous lesions: arteriovenous fistulae and arteriovenous malformations. Neurosurgery 59:3–195

    Google Scholar 

  10. Gavin CG, Kitchen ND (2011) Pathobiology of true arteriovenous malformations. Youmans Neurological Surgery. Elsevier, pp 4004–4015

    Chapter  Google Scholar 

  11. Malek AM, Halbach VV, Phatouros CC et al (1999) Spinal dural arteriovenous fistula with an associated feeding artery aneurysm: case report. Neurosurgery 44:877–880. https://doi.org/10.1097/00006123-199904000-00114

    Article  CAS  PubMed  Google Scholar 

  12. Fiaschi P, Prior A, Sbaffi PF et al (2019) Spinal dural arteriovenous fistulas: clinical results and quality of life assessment with surgical treatment as a crucial therapy. The joint experience of two centers. World Neurosurg 122:e270–e278. https://doi.org/10.1016/j.wneu.2018.10.019

    Article  PubMed  Google Scholar 

  13. Wilson DA, Abla AA, Uschold TD et al (2012) Multimodality treatment of conus medullaris arteriovenous malformations: 2 decades of experience with combined endovascular and microsurgical treatments. Neurosurgery 71:100–107. https://doi.org/10.1227/NEU.0b013e318256c042

    Article  PubMed  Google Scholar 

  14. Piotin M, Ross IB, Weill A et al (2001) Intracranial arterial aneurysms associated with arteriovenous malformations: endovascular treatment. Radiology 220:506–513. https://doi.org/10.1148/radiology.220.2.r01au09506

    Article  CAS  PubMed  Google Scholar 

  15. Pollock BE, Flickinger JC, Lunsford LD et al (1996) Factors that predict the bleeding risk of cerebral arteriovenous malformations. Stroke 27:1–6. https://doi.org/10.1161/01.STR.27.1.1

    Article  CAS  PubMed  Google Scholar 

  16. Rodesch G, Hurth M, Alvarez H et al (2004) Angio-architecture of spinal cord arteriovenous shunts at presentation. Clinical correlations in adults and children: the Bicêtre experience on 155 consecutive patients seen between 1981–1999. Acta Neurochir (Wien) 146:217–227. https://doi.org/10.1007/s00701-003-0192-1

    Article  CAS  Google Scholar 

  17. Konan AV, Raymond J, Roy D (1999) Transarterial embolization of aneurysms associated with spinal cord arteriovenous malformations. Report of four cases J Neurosurg 90:148–154. https://doi.org/10.3171/spi.1999.90.1.0148

    Article  CAS  PubMed  Google Scholar 

  18. Lavoie P, Raymond J, Roy D et al (2007) Selective treatment of an anterior spinal artery aneurysm with endosaccular coil therapy: case report. J Neurosurg Spine 6:460–464. https://doi.org/10.3171/spi.2007.6.5.460

    Article  PubMed  Google Scholar 

  19. SCOVILLE WB, (1948) Intramedullary arteriovenous aneurysm of the spinal cord; case report with operative removal from the conus medullaris. J Neurosurg 5:307–312. https://doi.org/10.3171/jns.1948.5.3.0307

    Article  Google Scholar 

  20. Binder B, Eng GD, Milhorat TH, Galioto F (1982) Spinal Arteriovenous Malformations in an Infant: unusual Symptomology and Pathology. Dev Med Child Neurol 24:380–385. https://doi.org/10.1111/j.1469-8749.1982.tb13631.x

    Article  CAS  PubMed  Google Scholar 

  21. Caroscio JT, Brannan T, Budabin M et al (1980) Subarachnoid hemorrhage secondary to spinal arteriovenous malformation and aneurysm: report of a case and review of the literature. Arch Neurol 37:101–103. https://doi.org/10.1001/archneur.1980.00500510059011

    Article  CAS  PubMed  Google Scholar 

  22. Ren Y, He M, You C, Li J (2018) Successful surgical resection of spinal artery aneurysms: report of 3 cases. World Neurosurg 109:171–178. https://doi.org/10.1016/j.wneu.2017.09.174

    Article  PubMed  Google Scholar 

  23. Zhang HJ, Silva N, Solli E et al (2020) Treatment options and long-term outcomes in pediatric spinal cord vascular malformations: a case report and review of the literature. Child’s Nerv Syst 36:3147–3152. https://doi.org/10.1007/s00381-020-04624-4

    Article  Google Scholar 

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Funding

The authors received no specific funding for this work.

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Author notes

  1. Bianca Baldassarre and Alberto Balestrino were equally contributed.

Authors and Affiliations

  1. Department of Neuroscience “Rita Levi Montalcini”, Neurosurgery Unit, University of Turin, Turin, Italy

    Bianca Baldassarre

  2. Division of Neurosurgery, Department of Neurosciences (DINOGMI), IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, Italy

    Alberto Balestrino, Alessandro D’Andrea, Pasquale Anania, Marco Ceraudo, Monica Truffelli, Ilaria Melloni, Gianluigi Zona & Pietro Fiaschi

  3. Department of Diagnostic and Interventional Neuroradiology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy

    Nicola Mavilio & Lucio Castellan

  4. Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy

    Gianluigi Zona & Pietro Fiaschi

Authors
  1. Bianca Baldassarre
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  2. Alberto Balestrino
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  3. Alessandro D’Andrea
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  4. Pasquale Anania
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Correspondence to Alberto Balestrino.

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Baldassarre, B., Balestrino, A., D’Andrea, A. et al. Management of spinal aneurysms associated with arteriovenous malformations: systematic literature review and illustrative case. Eur Spine J 30, 2767–2774 (2021). https://doi.org/10.1007/s00586-021-06881-6

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  • DOI: https://doi.org/10.1007/s00586-021-06881-6

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