Kang Joe, Gregg Lydia, Gailloud Philippe
Division of Interventional Neuroradiology, The Johns Hopkins Hospital, 1800 E Orleans Street, Bloomberg 7216, Baltimore, MD, 21287, USA.
Neuroradiology. 2017 Oct;59(10):1003-1012. doi: 10.1007/s00234-017-1888-x. Epub 2017 Aug 5.
Spinal vascular anomalies with arteriovenous blood shunting include spinal arteriovenous malformations (SAVMs) and spinal arteriovenous fistulas (SAVFs), which are distinguished by the presence or absence of an interposed nidus. SAVFs can be further characterized based on their location (perimedullary, dural, or extradural) and flow pattern (high-flow versus low-flow shunts). The spontaneous resolution of a spinal vascular malformation, i.e., the complete disappearance-in the absence of therapeutic measures-of a lesion previously identified by angiography, seems to represent an exceptional phenomenon.
This study retrospectively analyzed seven patients with spontaneously resolving spinal vascular malformations observed by the senior author between January 2008 and April 2017.
A total of 143 spinal vascular malformations were angiographically evaluated during the considered time period, including nine spontaneously resolving SAVFs in six patients, seven spinal epidural fistulas, and two spinal dural arteriovenous fistula.
The "spontaneous" resolution of spinal vascular malformations appears to selectively involve SAVFs. While vessel wall alterations previously documented on the venous side of SAVFs may play an important role in the regression of these lesions, angiography seems to represent a significant contributing factor, probably through the prothrombotic properties of nonionic contrast agents.
伴有动静脉血液分流的脊柱血管异常包括脊柱动静脉畸形（SAVM）和脊柱动静脉瘘（SAVF），它们通过是否存在中间病灶来区分。SAVF可根据其位置（髓周、硬脊膜或硬膜外）和血流模式（高流量与低流量分流）进一步分类。脊柱血管畸形的自然消退，即在未采取治疗措施的情况下，先前经血管造影确定的病变完全消失，似乎是一种罕见现象。
本研究回顾性分析了2008年1月至2017年4月期间资深作者观察到的7例自然消退的脊柱血管畸形患者。
在研究期间，共对143例脊柱血管畸形进行了血管造影评估，其中包括6例患者的9例自然消退的SAVF、7例脊柱硬膜外瘘和2例脊柱硬脊膜动静脉瘘。
脊柱血管畸形的“自然”消退似乎选择性地累及SAVF。虽然先前在SAVF静脉侧记录的血管壁改变可能在这些病变的消退中起重要作用，但血管造影似乎是一个重要的促成因素，可能是通过非离子型造影剂的促血栓形成特性。
