Spinal vascular malformations: Diagnostic and therapeutic management [Spinale vaskuläre malformationen: Diagnostik und therapie]

Spinal vascular malformations are rare diseases with a wide variety of neurological presentations. In this article spinal cavernomas, arteriovenous malformations (both from the fistulous and glomerular type), and spinal dural arteriovenous fistulae are described and an overview about their imaging features on magnetic resonance imaging (MRI) and digital subtraction angiography is given. Clinical differential diagnoses, the neurological symptomatology and the potential therapeutic approaches of these diseases which vary depending on the underlying pathology are given. Although MRI constitutes the diagnostic modality of first choice in suspected spinal vascular malformation, a definite diagnosis of the disease and therefore the choice of suited therapeutic approach rest on selective spinal angiography. Treatment in symptomatic patients offers an improvement in the prognosis. In most spinal vascular malformations except for spinal cavernomas, the endovascular approach is the method of first choice; in selected cases a combined or surgical therapy might be considered. © 2006 Urban & Vogel München.