Radiosurgery for Spinal Intramedullary Arteriovenous Malformations: A Literature Review

 

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Abstract

Introduction Intramedullary spinal cord arteriovenous malformations (SCAVMs) comprise only 3 to 4% of spinal cord pathologies and are often not amenable to total resection due to extensive involvement with spinal cord parenchyma and multiple arterial feeding vessels.

Methods A electronic database search from 1966 to February 28, 2014, was conducted for relevant articles using the keywords and Medical Subject Headings strings spinal arteriovenous malformation, spinal radiosurgery, spinal vascular malformation, and radiosurgery for vascular lesions. Target outcomes measures were nidus obliteration, neurologic improvement, and complication rate.

Results Four retrospective articles containing a total of 30 patients were identified that described patients with SCAVMs presenting with symptomatic intramedullary or subarachnoid hemorrhage. Eighteen patients underwent treatment with CyberKnife with dosages ranging from 21 to 40 Gy (or a maximum biological equivalent dose of 58 Gy for early treatment effect) (Accuray, Inc., Sunnyvale, California, United States), 10 with a linear accelerator and real-time respiratory tracking ranging from 32 to 40 Gy, and 2 patients with external-beam radiotherapy receiving 45 Gy and 50 Gy, respectively. The mean time for clinical follow-up was 43.5 months (range: 27.9–60 months). There were no cases of spinal cord hemorrhage after radiosurgery. Nor were there any cases of neurologic worsening or signs and symptoms of neuropathic pain or myelitis. A total of 29 of the 30 patients obtained follow-up.

• References

• 1 Martirosyan NL, Feuerstein JS, Theodore N, Cavalcanti DD, Spetzler RF, Preul MC. Blood supply and vascular reactivity of the spinal cord under normal and pathological conditions. J Neurosurg Spine 2011; 15 (3) 238-251
  CrossrefPubMedGoogle Scholar
• 2 Spetzler RF, Detwiler PW, Riina HA, Porter RW. Modified classification of spinal cord vascular lesions. J Neurosurg 2002; 96 (2, Suppl): 145-156
  CrossrefPubMedGoogle Scholar
• 3 Anson JA, Spetzler RF. Interventional neuroradiology for spinal pathology. Clin Neurosurg 1992; 39: 388-417
  PubMedGoogle Scholar
• 4 Barontini F, Tonini R. A case of necrotic myelopathy due to a spinal vascular malformation (Foix-Alajouanine's disease). Schweiz Arch Neurol Neurochir Psychiatr 1981; 128 (1) 5-12
  PubMedGoogle Scholar
• 5 Cahan LD, Higashida RT, Halbach VV, Hieshima GB. Variants of radiculomeningeal vascular malformations of the spine. J Neurosurg 1987; 66 (3) 333-337
  CrossrefPubMedGoogle Scholar
• 6 Djindjian M, Djindjian R, Rey A, Hurth M, Houdart R. Intradural extramedullary spinal arterio-venous malformations fed by the anterior spinal artery. Surg Neurol 1977; 8 (2) 85-93
  PubMedGoogle Scholar
• 7 Krayenbühl H, Yaşargil MG, McClintock HG. Treatment of spinal cord vascular malformations by surgical excision. J Neurosurg 1969; 30 (4) 427-435
  CrossrefPubMedGoogle Scholar
• 8 Malis LI. Intramedullary spinal cord tumors. Clin Neurosurg 1978; 25: 512-539
  PubMedGoogle Scholar
• 9 Spetzler RF, Zabramski JM, Flom RA. Management of juvenile spinal AVM's by embolization and operative excision. Case report. J Neurosurg 1989; 70 (4) 628-632
  CrossrefPubMedGoogle Scholar
• 10 Potharaju M, John R, Venkataraman M, Gopalakrishna K, Subramanian B. Stereotactic radiosurgery results in three cases of intramedullary spinal cord arteriovenous malformations. Spine J 2014; 14 (11) 2582-2588
  CrossrefPubMedGoogle Scholar
• 11 Than KD, Sangala JR, Wang AC, Gandhi D, La Marca F, Park P. The current status and recent advances in high-resolution imaging of spinal vascular malformations. J Clin Neurosci 2013; 20 (1) 66-71
  CrossrefPubMedGoogle Scholar
• 12 Mokin M, Dumont TM, Levy EI. Novel multimodality imaging techniques for diagnosis and evaluation of arteriovenous malformations. Neurol Clin 2014; 32 (1) 225-236
  CrossrefPubMedGoogle Scholar
• 13 Novakovic RL, Lazzaro MA, Castonguay AC, Zaidat OO. The diagnosis and management of brain arteriovenous malformations. Neurol Clin 2013; 31 (3) 749-763
  CrossrefPubMedGoogle Scholar
• 14 Zozulya YP, Slin'ko EI, Al-Qashqish II. Spinal arteriovenous malformations: new classification and surgical treatment. Neurosurg Focus 2006; 20 (5) E7
  CrossrefPubMedGoogle Scholar
• 15 Voleti PB, Donegan DJ, Kim TW, Lee GC. Level of evidence: does it change the rate of publication and time to publication of American Academy of Orthopaedic Surgeons presentations?. J Bone Joint Surg Am 2013; 95 (1) e2
  CrossrefPubMedGoogle Scholar
• 16 Connolly Jr ES, Zubay GP, McCormick PC, Stein BM. The posterior approach to a series of glomus (Type II) intramedullary spinal cord arteriovenous malformations. Neurosurgery 1998; 42 (4) 774-785 ; discussion 785–786
  CrossrefPubMedGoogle Scholar
• 17 Boström A, Krings T, Hans FJ, Schramm J, Thron AK, Gilsbach JM. Spinal glomus-type arteriovenous malformations: microsurgical treatment in 20 cases. J Neurosurg Spine 2009; 10 (5) 423-429
  CrossrefPubMedGoogle Scholar
• 18 Velat GJ, Chang SW, Abla AA, Albuquerque FC, McDougall CG, Spetzler RF. Microsurgical management of glomus spinal arteriovenous malformations: pial resection technique: Clinical article. J Neurosurg Spine 2012; 16 (6) 523-531
  CrossrefPubMedGoogle Scholar
• 19 Wang G, Ma G, Ma J , et al. Surgical treatment of spinal vascular malformations performed using intraoperative indocyanine green videoangiography. J Clin Neurosci 2013; 20 (6) 831-836
  CrossrefPubMedGoogle Scholar
• 20 Sinclair J, Chang SD, Gibbs IC, Adler Jr JR. Multisession CyberKnife radiosurgery for intramedullary spinal cord arteriovenous malformations. Neurosurgery 2006; 58 (6) 1081-1089 ; discussion 1081–1089
  CrossrefPubMedGoogle Scholar
• 21 Chang SD, Shuster DL, Steinberg GK, Levy RP, Frankel K. Stereotactic radiosurgery of arteriovenous malformations: pathologic changes in resected tissue. Clin Neuropathol 1997; 16 (2) 111-116
  PubMedGoogle Scholar
• 22 Singhal AB, Drago S, Sheth SG, Chowgule BR, Nabar ST. Ruptured type III cervical spinal cord arteriovenous malformation as a cause of acute quadriparesis. J Assoc Physicians India 1995; 43 (8) 565-566
  PubMedGoogle Scholar
• 23 Colombo F, Pozza F, Chierego G, Francescon P, Casentini L, De Luca G. Linear accelerator radiosurgery of cerebral arteriovenous malformations: current status. Acta Neurochir Suppl (Wien) 1994; 62: 5-9
  PubMedGoogle Scholar
• 24 Friedman WA, Blatt DL, Bova FJ, Buatti JM, Mendenhall WM, Kubilis PS. The risk of hemorrhage after radiosurgery for arteriovenous malformations. J Neurosurg 1996; 84 (6) 912-919
  CrossrefPubMedGoogle Scholar
• 25 Thariat J, Fric D, Kerr C , et al. Advances in radiation oncology for metastatic bone disease. [in French]. Bull Cancer 2013; 100 (11) 1187-1197
  PubMedGoogle Scholar
• 26 Gerszten PC, Burton SA, Ozhasoglu C. CyberKnife radiosurgery for spinal neoplasms. Prog Neurol Surg 2007; 20: 340-358
  PubMedGoogle Scholar
• 27 Lee YK, Bedford JL, McNair HA, Hawkins MA. Comparison of deliverable IMRT and VMAT for spine metastases using a simultaneous integrated boost. Br J Radiol 2013; 86 (1022) 20120466
  CrossrefPubMedGoogle Scholar
• 28 Emami B, Lyman J, Brown A , et al. Tolerance of normal tissue to therapeutic irradiation. Int J Radiat Oncol Biol Phys 1991; 21 (1) 109-122
  PubMedGoogle Scholar
• 29 Kirkpatrick JP, van der Kogel AJ, Schultheiss TE. Radiation dose-volume effects in the spinal cord. Int J Radiat Oncol Biol Phys 2010; 76 (3, Suppl): S42-S49
  CrossrefPubMedGoogle Scholar
• 30 Parikh S, Heron DE. Fractionated radiosurgical management of intramedullary spinal cord metastasis: a case report and review of the literature. Clin Neurol Neurosurg 2009; 111 (10) 858-861
  CrossrefPubMedGoogle Scholar
• 31 Crowley RW, Sherman JH, Le BH, Jane Sr JA. Intramedullary spinal cord metastasis from bladder carcinoma: case report. Neurosurgery 2008; 63 (3) E611-E612 ; discussion E612
  CrossrefPubMedGoogle Scholar
• 32 Schijns OE, Kurt E, Wessels P, Luijckx GJ, Beuls EA. Intramedullary spinal cord metastasis as a first manifestation of a renal cell carcinoma: report of a case and review of the literature. Clin Neurol Neurosurg 2000; 102 (4) 249-254
  CrossrefPubMedGoogle Scholar
• 33 Abdulazim A, Backhaus M, Stienen MN , et al. Intramedullary spinal cord metastasis and multiple brain metastases from urothelial carcinoma. J Clin Neurosci 2011; 18 (10) 1405-1407
  CrossrefPubMedGoogle Scholar
• 34 Douglas JG, Goodkin R. Treatment of arteriovenous malformations using Gamma Knife surgery: the experience at the University of Washington from 2000 to 2005. J Neurosurg 2008; 109 (Suppl): 51-56
  PubMedGoogle Scholar
• 35 Rodesch G, Hurth M, Alvarez H, Lasjaunias P. Embolisation of spinal cord arteriovenous malformations with glue through the anterior spinal axis. Review of 20 cases. Interv Neuroradiol 1997; 3 (2) 131-143
  PubMedGoogle Scholar
• 36 Riché MC, Melki JP, Merland JJ. Embolization of spinal cord vascular malformations via the anterior spinal artery. AJNR Am J Neuroradiol 1983; 4 (3) 378-381
  PubMedGoogle Scholar
• 37 Corkill RA, Mitsos AP, Molyneux AJ. Embolization of spinal intramedullary arteriovenous malformations using the liquid embolic agent, Onyx: a single-center experience in a series of 17 patients. J Neurosurg Spine 2007; 7 (5) 478-485
  CrossrefPubMedGoogle Scholar
• 38 Rodesch G, Hurth M, Alvarez H, David P, Tadie M, Lasjaunias P. Embolization of spinal cord arteriovenous shunts: morphological and clinical follow-up and results—review of 69 consecutive cases. Neurosurgery 2003; 53 (1) 40-49 ; discussion 49–50
  CrossrefPubMedGoogle Scholar
• 39 Lv X, Li Y, Yang X, Jiang C, Wu Z. Endovascular embolization for symptomatic perimedullary AVF and intramedullary AVM: a series and a literature review. Neuroradiology 2012; 54 (4) 349-359
  CrossrefPubMedGoogle Scholar
• 40 Hida K, Shirato H, Isu T , et al. Focal fractionated radiotherapy for intramedullary spinal arteriovenous malformations: 10-year experience. J Neurosurg 2003; 99 (1, Suppl): 34-38
  PubMedGoogle Scholar
• 41 Wolkov HB, Bagshaw M. Conventional radiation therapy in the management of arteriovenous malformations of the central nervous system. Int J Radiat Oncol Biol Phys 1988; 15 (6) 1461-1464
  CrossrefPubMedGoogle Scholar