Spinal Arteriovenous Malformation Resection

The success of the surgical treatment of spinal vascular malformation was a case of venous dilatation in Elsberg in 1914. In 1969, Ommaya divided the spinal vascular malformations into three types according to the findings of spinal angiography: 1 juvenile anomaly. Much like the brain AVM, there are multiple arteries supplying blood, rapid blood flow, audible noise, and close connection with the spinal cord, not only limited to the dorsal aspect of the spinal cord, but also in the spinal cord, almost all in children and young people. Surgical removal has certain difficulties. 2 spherical (glomus anomaly). For the accumulation of localized small vessel malformations, a large number of small, tightly deformed blood vessels form a large vascular mass, similar to a spherical capillary plexus, mostly located under the soft membrane on the dorsal side of the spinal cord or within the spinal cord. In the segment, the blood supply artery is a single thickened spinal artery, the blood flow is slow, and some can be successfully removed. The above two types account for only 15% to 20% of spinal vascular malformations. 3 single coiled vessel anomaly. There is only one blood supply artery. This blood supply artery does not supply blood to the spinal cord, and has only small microvascular traffic with the spinal cord. The deformity consists of a long, irregular, curved blood vessel that travels along the dorsal surface of the spinal cord and has a slow blood flow. In 1987, after reviewing 81 cases of intraspinal vascular malformations, Rosenblum re-divided the spinal vascular malformations in the spinal cord into AVM in the spinal cord and arteriovenous fistula in the arteriovenous direct traffic. All the feeding arteries of spinal cord vascular malformation are from the anterior or posterior spinal cord. The malformed vascular mass (nidus) of the AVM in the spinal cord is either located in the spinal cord or under the subdural. It can be subdivided into: 1 spherical AVM, the deformed vascular group is relatively limited, and blood is supplied by a single artery. The young juvenile AVM supplies blood to a number of blood vessels, and the deformed vascular mass is large and widely occupies the entire cross section of the spinal cord. Arteriovenous fistulas with direct arteriovenous communication do not see deformed vascular masses, but direct communication between arteries and veins, either in the spinal cord or beside the spinal cord. Treatment of diseases: subarachnoid hemorrhage spinal cord compression Indication Spinal arteriovenous malformation is suitable for: 1. There is spinal cord dysfunction, especially if the symptoms are progressively worse or have a tendency to develop. 2, subarachnoid hemorrhage or intraspinal hematoma. 3. There are people with severe nerve root pain that are difficult to control. Contraindications 1, the damage of the spinal cord function of the lesion has reached the late stage, showing complete stenosis of the spinal cord. 2, the patient is old and frail, combined with other chronic diseases, difficult to tolerate the operator. Preoperative preparation Selective spinal angiography, clear the number and location of the blood supply artery, the location of the deformed vascular mass and the extent of the drainage vein to facilitate the development of the best surgical plan. Surgical procedure 1. The median incision is made in the back. The length of the incision should include the area where the blood supply artery and the malformed vascular mass can be treated. According to the general spinal surgery approach, the lamina was removed to reveal the dura mater in the lesion. The epidural venous plexus within this range is generally underdeveloped. 2, the median incision of the dura mater, you can see the deformed blood vessels under the subarachnoid expansion. The dura mater is pulled to the sides to fully reveal the lesion. The blood supply artery running from the intervertebral foramen to the spinal cord in parallel with the nerve root is cut by bipolar coagulation or silver clip. 3, the arachnoid incision in the middle, in the upper and lower ends of the field with bipolar coagulation and cut off the drainage vein, from the ends to the center will be located in the spinal cord or partially in the spinal cord, part of the isolated spinal cord outside the deformed blood vessels The mass was free, and the lesion was gradually removed with a stripper, a cotton piece, a fine-headed aspirator, and bipolar electrocoagulation. 4. After strict hemostasis, the incision is closed by conventional suture. complication 1, postoperative bleeding or intraspinal hematoma: mainly related to incomplete hemostasis, such as postoperative anticoagulant therapy should pay more attention. 2, increased spinal cord dysfunction: may be related to surgical operations, but also due to blood supply artery blockade after spinal cord insufficiency.