Treatment Strategies for Spinal Arteriovenous Shunt Diseases : Embolization or Surgery?

Abstract

  Embolization does not require removal of the lamina or vertebral body and allows for multidirectional observation of the spinal cord vessels. However, because the catheter may not reach the shunt due to tortuosity or narrowness, there is a risk of uncertain occlusion and intrusion of embolic substances. Surgery is an easy and reliable method to disconnect the shunt at the accessible sites ; however, there is limited visibility of the spinal cord vessels and it is difficult to reach the ventral or the inner side of the spinal cord.

  In a spinal dural arteriovenous fistula, the radiculomeningeal artery is strongly tortuous ; therefore, surgical dissection is more reliable than embolization. In a spinal epidural arteriovenous fistula, embolization is easy because the dorsal somatic branch is relatively straight and transvenous coil embolization is also possible. Perimedullary arteriovenous fistulas and craniocervical junction arteriovenous shunt can be completely cured with embolization if the shunting point is clear and can be reached with a catheter. However, if a surgical approach is possible, disconnection is easy and safe. In contrast, intramedullary arteriovenous malformations cannot be completely cured. Palliative treatment, such as partially targeted embolization, is indicated.