Embolization of Spinal Arteriovenous Malformations

Abstract

Operative embolization techniques were pioneered by neurosurgeons (Brooks, 1930; Luessenhop and Spence, 1960) and were directed principally at carotid-cavernous fistulas and cerebral arteriovenous malformations. Embolization through percutaneously placed catheters, a logical progression from the more cumbersome surgical approach, was developed by radiologists seeking a more controlled method for achieving intravascular occlusion. In fact, the first successful transcatheter embolization was directed at spinal arteriovenous malformations (Doppman et al., 1968; Newton and Adams, 1968). We embolized our first spinal arteriovenous malformation in October, 1967 and have since embolized 17 more lesions. Current embolizing materials are not ideal, and in most instances the technique is not curative, at least in the same sense as a complete surgical excision. But as a preoperative measure to reduce vascularity and facilitate resection or as a palliative measure in unresectable lesions, transcatheter embolization substantially contributes to the care of these patients.