Daou Badih, Atallah Elias, Al-Saiegh Fadi, Alkhalili Kenan, Tjoumakaris Stavropoula, Rosenwasser Robert H, Jabbour Pascal
Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA.
Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA.
World Neurosurg. 2017 Feb;98:874.e1-874.e6. doi: 10.1016/j.wneu.2016.11.123. Epub 2016 Dec 3.
Spinal arteriovenous malformations (AVMs) are rare lesions that may cause serious neurologic morbidity. With developments in endovascular technology and embolic materials, endovascular management of spinal AVMs has gained popularity.
A 61-year-old woman presented with the worst headache of her life and an acute onset of nausea and vomiting and was shown to have a grade 2 subarachnoid hemorrhage (SAH) on computed tomography scan. A 6-vessel cerebral angiogram was negative for any vascular abnormalities. Magnetic resonance imaging and magnetic resonance angiography of the neck showed a flow-related enhancement compatible with a vascular abnormality at the level of C2. Cervical spinal angiography showed a cervical spinal cord glomus (type II) AVM at the level of C2 draining into perimedullary venous plexus. Transarterial Onyx embolization was performed and resulted in complete occlusion of the AVM. The patient made a complete neurologic recovery.
Spinal AVMs manifesting as intracranial SAH are uncommon. These lesions are frequently overlooked on cerebral angiography and account for a small proportion of angiogram-negative SAHs. A negative angiogram in the setting of SAH should prompt a comprehensive evaluation of the cervical segmental arterial supply to exclude a cervical spinal AVM. Endovascular embolization may be effective in treating spinal glomus AVMs with good clinical outcomes and with complete angiographic obliteration. Onyx embolic agent should be considered as the agent of choice to manage spinal glomus AVMs.
脊髓动静脉畸形（AVM）是罕见的病变，可导致严重的神经功能障碍。随着血管内技术和栓塞材料的发展，脊髓AVM的血管内治疗越来越受欢迎。
一名61岁女性出现一生中最严重的头痛，并急性发作恶心和呕吐，计算机断层扫描显示为2级蛛网膜下腔出血（SAH）。六血管脑血管造影未发现任何血管异常。颈部磁共振成像和磁共振血管造影显示与C2水平血管异常相符的血流相关强化。颈脊髓血管造影显示C2水平有一个颈脊髓球型（II型）AVM，引流至髓周静脉丛。进行了经动脉Onyx栓塞，导致AVM完全闭塞。患者神经功能完全恢复。
表现为颅内SAH的脊髓AVM并不常见。这些病变在脑血管造影中常被忽视，在血管造影阴性的SAH中占比很小。SAH情况下的血管造影阴性应促使对颈段动脉供血进行全面评估，以排除颈脊髓AVM。血管内栓塞可能有效治疗脊髓球型AVM，临床效果良好，血管造影完全闭塞。应考虑将Onyx栓塞剂作为治疗脊髓球型AVM的首选药物。
