Ahead of Print: Cervical Perimedullary Arteriovenous Shunts

Screen Shot 2014-07-16 at 11.17.13 AMBackground: Reports of cervical perimedullary arteriovenous shunt (PMAVS) are limited, and treatment strategies have not been established.

Objective: To describe angioarchitecture and optimal treatment strategies for cervical PMAVS.

Methods: We treated 22 cases of cervical PMAVS between 2000 and 2012 (8 women and 14 men; age, 9-80 years). According to the classification, our cases included Type IVa (4 cases), Type IVb (16 cases), and Type IVc (2 cases). Seventeen patients presented with subarachnoid hemorrhage.

Results: A total of 41 shunting points were localized in 22 cases, of which 34 points were located ventral or ventrolateral to the spinal cord. Anterior spinal artery (ASA) contributed to the shunts in 16 cases. Aneurysm formation was identified in 8 cases. Endovascular treatments were attempted in 3 cases, resulting in complete obliteration in 1 case (Type IVc). Overall, 21 patients underwent an open surgery. An anterior approach with corpectomy was elected for 2 cases; the other 19 cases underwent the posterior approaches utilizing indocyanine green videoangiography, intraoperative angiography, endoscopy (8 cases), and neuromonitoring. Twenty patients were rated as good recovery at 6 months after surgery. No recurrence was observed in any patients during the follow-up (mean, 59.7 months).

Conclusion: Shunting points of the cervical PMAVS were predominantly located ventral or ventrolateral to the spinal cord and were often fed by ASA. Even for ventral lesions, posterior exposure assisted with neuromonitoring and endoscopy, and intraoperative angiography provided a sufficient view to understand relationships between the shunts and ASA, and contributed to good surgical outcomes.

From: Cervical Perimedullary Arteriovenous Shunts: A Study of 22 Consecutive Cases With a Focus on Angioarchitecture and Surgical Approaches by Endo et al.

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