Skip to main content

Advertisement

SpringerLink
Log in

Vascular Diseases of the Spinal Cord: A Review

  • CEREBROVASCULAR DISORDERS (HP ADAMS JR, SECTION EDITOR)
  • Published:
Current Treatment Options in Neurology Aims and scope Submit manuscript

Opinion statement

• In acute spinal cord ischemia syndrome (ASCIS), treatment recommendations are derived from data of cerebral ischemic stroke, atherosclerotic vascular disease and acute spinal cord injury. Besides acute management, secondary prevention is of major importance. Pathologies affecting the aorta as well as underlying cerebrovascular conditions should be treated whenever possible.

• ASCIS may occur after aortic surgery, less often after thoracic endovascular aortic repair (TEVAR). Protocols are proposed.

• Acute spinal cord hemorrhage can be treated surgically and/or pharmacologically.

• Symptomatic treatment in patients with a spinal cord lesion is of major importance. Depending on level and extension of the lesion, there is a risk for systemic and neurological complications, which may be life-threatening.

• Each spinal vascular malformation is a unique lesion that needs an individualized treatment algorithm. In case of a symptomatic vascular malformation, endovascular intervention is the primary treatment option.

• Spinal dural Arteriovenous fistula (AVF) may be treated endovascularly or surgically. If preoperative localization of the fistula is possible, surgery is feasible with a low complication rate. In comparison, endovascular approaches are less invasive.

• Spinal AVM are rather treated endovascularly than surgically or in a stepwise multidisciplinary approach.

• Symptomatic and exophytic spinal cavernous angiomas should be treated surgically. Deep spinal cavernous angiomas that are asymptomatic or only show mild symptoms can be observed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1

Similar content being viewed by others

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Nedeltchev K, Loher TJ, Stepper F, et al. Long-term outcome of acute spinal cord ischemia syndrome. Stroke. 2004;35:560–5.

    Article  PubMed  Google Scholar 

  2. Mumenthaler M, Mattle H, editors. Neurologie 12th ed. Stuttgart: Georg Thieme Verlag, 2008; pp 363–7.

  3. Cheshire WP, Santos CC, Massey EW, et al. Spinal cord infarction: etiology and outcome. Neurology. 1996;47:321.

    Article  PubMed  CAS  Google Scholar 

  4. Messé SR, Bavaria JE, Mullen M, et al. Neurologic outcomes from high risk descending thoracic and thoracoabdominal aortic operations in the era of endovascular repair. Neurocrit Care. 2008;9:344. This paper shows the benefit of TEVAR in descending thoracic and thoracoabdominal aortic interventions.

    Article  PubMed  Google Scholar 

  5. Restrepo L, Guttin JF. Acute spinal cord ischemia during angiography treated with intravenous thrombolytic therapy. Tex Heart Inst J. 2006;33:74.

    PubMed  Google Scholar 

  6. Transverse Myelitis Consortium Working Group. proposed diagnostic criteria and nosology of acute transverse myelitis. Neurology. 2002;59:499–505.

    Article  Google Scholar 

  7. Geldmacher DS, Bowen BC. Spinal cord vascular disease. In: Bradley WG, Daroff RB, Fenichel GM, Marsden CD, editors. Neurology in clinical practice principles of diagnosis and management. 4th ed. Philadelphia: Butterworth-Heimann; 2004. p. 1313–22.

    Google Scholar 

  8. Masson C, Pruvo JP, Meder JF, et al. Spinal cord infarction: clinical and magnetic resonance imaging findings and short term outcome. J Neurol Neurosurg Psychiatry. 2004;75:1431.

    Article  PubMed  CAS  Google Scholar 

  9. De Seze M, De Seze M, Joseph PA, et al. Functional prognosis of paraplegia due to cord ischemia: a retrospective study of 23 patients. Rev Neurol (Paris). 2003;159:1038–45.

    Google Scholar 

  10. Adams Jr HP, del Zoppo G, Alberts MJ, et al. Guidelines for the early management of adults with ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease, and Quality of Care Outcomes in Research Interdisciplinary Working Groups: The American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists. Circulation. 2007;115:e478. This paper gives a good overview concerning management of acute ischemic stroke.

    Article  PubMed  Google Scholar 

  11. Furie KL, Kasner SE, Adams RJ, et al. Guidelines for the prevention of stroke in patients with stroke or transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2011;42:227–76. This paper gives a good overview concerning prevention of stroke in patients with stroke or transient ischemic attack.

    Article  PubMed  Google Scholar 

  12. Kreppel D, Antoniadis G, Seeling W. Spinal hematoma: a literature survey with meta-analysis of 613 patients. Neurosurg Rev. 2003;26:1–49.

    Article  PubMed  CAS  Google Scholar 

  13. Leep Hunderfund AN, Wijdicks EF. Intramedullary spinal cord hemorrhage (hematomyelia). Rev Neurol Dis. 2009;6:E54–61.

    PubMed  Google Scholar 

  14. Lev N, Maimon S, Rappaport ZH, et al. Spinal dural arteriovenous fistulae: a diagnostic challenge. Isr Med Assoc J. 2001;3:492.

    PubMed  CAS  Google Scholar 

  15. Krings T, Lasjaunias P, Reinges MHT, et al. Spinal vascular malformations. Diagnostic and therapeutic management. Clin Neuroradiol. 2006;4:217–27.

    Article  Google Scholar 

  16. Van Dijk JM, TerBrugge KG, Willinsky RA, et al. Multidisciplinary management of spinal dural arteriovenous fistulas. Clinical presentation and long-term follow-up in 49 patients. Stroke. 2002;33:1578–83.

    Article  PubMed  Google Scholar 

  17. Huffmann BC, Gilsbach JM, Thron A. Spinal dural arteriovenous fistulas: a plea for neurosurgical treatment. Acta Neurochir. 1995;135:44–51.

    Article  CAS  Google Scholar 

  18. Berenstein A, Lasjaunias P, TerBrugge KG. Clinical and endovascular treatment aspects in adults. In: Berenstein A, Lasjaunias P, TerBrugge KG, editors. Surgical Neuroangiography 2.2. Berlin: Springer; 2004. p. 737–872.

    Chapter  Google Scholar 

  19. Fugate JE, Lanzino G, Rabinstein AA. Clinical presentation and prognostic factors of spinal dural arteriovenous fistulas: an overview. Neurosurg Focus. 2012;32:E17.

    Article  PubMed  Google Scholar 

  20. Bemporad JA, Sze GS. MR imaging of spinal cord vascular malformations with an emphasis on the cervical spine. Magn Reson Imaging Clin N Am. 2000;8:581.

    PubMed  CAS  Google Scholar 

  21. Gross BA, Du R, Popp AJ, Day AL. Intramedullary spinal cord cavernous malformations. Neurosurg Focus. 2010;29:E14.

    Article  PubMed  Google Scholar 

  22. Zevgaridis D, Medele RJ, Hamburger C, et al. Cavernous haemangiomas of the spinal cord. A review of 117 cases. Acta Neurochirurgica. 1999;141:237–45.

    Article  PubMed  CAS  Google Scholar 

  23. Kharkar S, Shuck J, Conway J, Rigamonti D. The natural history of conservatively managed symptomatic intramedullary spinal cord cavernomas. Neurosurgery. 2007;60:865–72.

    Article  PubMed  Google Scholar 

  24. Wachter D, Psychogios M, Gilsbach JM, Rohde V. Spinal cord cavernoma-operative strategy and results in 30 patients. J Neurol Surg A Cent Eur Neurosurg. 2012;73:125–31.

    Article  PubMed  Google Scholar 

  25. Baba H, Tomita K, Kawagishi T, Imura S. Anterior spinal artery syndrome. Int Orthop. 1993;17:353.

    PubMed  CAS  Google Scholar 

  26. The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group: tissue plasminogen activator for acute ischemic stroke. N Engl J Med. 1995;333:1581–1587.

    Google Scholar 

  27. Hacke W, Kaste M, Bluhmki E, et al. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med. 2008;359:1317–29.

    Article  PubMed  CAS  Google Scholar 

  28. Grabenwöger M, Alfonso F, Bachet J, et al. Thoracic Endovascular Aortic Repair (TEVAR) for the treatment of aortic diseases: a position statement from the European Association for Cardio-Thoracic Surgery (EACTS) and the European Society of Cardiology (ESC), in collaboration with the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur J Cardiothorac Surg. 2012; (Epub ahead of print).

  29. McGarvey ML, Cheung AT, Szeto W, Messé SR. Management of neurologic complications of thoracic aortic surgery. J Clin Neurophysiol. 2007;24:336.

    PubMed  Google Scholar 

  30. Lüllmann H, Mohr K, Wehling M, Lüllmann H, Mohr K, Wehling M. editors. Stuttgart: Thieme, 15th edition. Pharmacol Toxicol. 2003;177–84:370–6.

    Google Scholar 

  31. Groen RJM. Non-operative treatment of spontaneous spinal epidural hematomas: a review of the literature and a comparison with operative cases. Acta Neurochir (Wien). 2004;146:103–10.

    Article  CAS  Google Scholar 

  32. Daentzer D, Boker DK. Spontaneous spinal hemorrhage. Outcome after surgical therapy of epidural hematomas. Der Nervenarzt. 2000;71:116–22.

    Article  PubMed  CAS  Google Scholar 

  33. Duffill J, Sparrow OC, Millar J, Barker CS. Can spontaneous spinal epidural haematoma be managed safely without operation? A report of 4 cases. J Neurol Neurosurg Psychiatry. 2000;69:816–9.

    Article  PubMed  CAS  Google Scholar 

  34. Domenicucci M, Ramieri A, Paolini S, et al. Spinal subarachnoid hematomas: our experience and literature review. Acta Neurochir. 2005;147:741–50.

    Article  CAS  Google Scholar 

  35. Markandaya M, Stein M, Menaker J. Acute treatment options for spinal cord injury. Curr Treat Options Neurol. 2012;14:175–87. Even though this paper primarily addresses traumatic spinal cord injury, many management recommendations may be applied to ASCIS and acute spinal cord hemorrhage as well.

    Article  Google Scholar 

  36. Bycroft J, Shergill IS, Chung EA, et al. Autonomic dysreflexia: a medical emergency. Postgrad Med J. 2005;81:232.

    Article  PubMed  CAS  Google Scholar 

  37. Geerts WH, Bergquist D, Pineo GF, et al. Prevention of venous thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th edition). Chest. 2008;133:381S–453S. This paper provides evidence-based guidelines for the use of thromboprophylaxis in a variety of clinical situations.

    Article  PubMed  CAS  Google Scholar 

  38. Raslan AM, Fields JD, Bhardwaj A. Prophylaxis for venous thrombo-embolism in neurocritical care: a critical appraisal. Neurocrit Care. 2010;12:297–309. This paper provides a critical appraisal concerning the use of thromboprophylaxis including in ASCIS.

    Article  PubMed  Google Scholar 

  39. Niimi Y, Berenstein A, Setton A, Neophytides A. Embolization of spinal dural arteriovenous fistulae: results and follow-up. Neurosurgery. 1997;40:675–82. discussion 682–3.

    Article  PubMed  CAS  Google Scholar 

  40. Krings T, Thron AK, Geibprasert S, et al. Endovascular management of spinal vascular malformations. Neurosurg Rev. 2010;33:1–9. This paper discusses interventional and surgical management of spinal vascular malformations.

    Article  PubMed  Google Scholar 

  41. Behrens S, Thron A. Long-term follow-up and outcome in patients treated for spinal dural arteriovenous fistulae. J Neurol. 1999;246:181–5.

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgment

The authors thank Marwan El-Koussy for providing the figures.

Disclosures

No potential conflicts of interest relevant to this article were reported.

Author information

Authors and Affiliations

  1. Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland

    Mirjam Rachel Heldner MD, Marcel Arnold MD & Urs Fischer MD, MSc

  2. Department of Neurology, Triemli Hospital, Zurich, Switzerland

    Krassen Nedeltchev MD

  3. Department of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland

    Jan Gralla MD, MSc

  4. Department of Neurosurgery, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland

    Jürgen Beck MD

Authors
  1. Mirjam Rachel Heldner MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marcel Arnold MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Krassen Nedeltchev MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jan Gralla MD, MSc
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jürgen Beck MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Urs Fischer MD, MSc
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Urs Fischer MD, MSc.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Heldner, M.R., Arnold, M., Nedeltchev, K. et al. Vascular Diseases of the Spinal Cord: A Review. Curr Treat Options Neurol 14, 509–520 (2012). https://doi.org/10.1007/s11940-012-0190-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11940-012-0190-9

Keywords

Search

Navigation