Diagnosis and Endovascular Treatment of Vascular Lesions of the Spine and Spinal Cord

Summary

An extensive body of literature has appeared during the past three decades regarding the diagnosis of vascular lesions of the spine and spinal cord utilizing myelography, computed tomography (CT) with intravenous contrast enhancement or following myelography, magnetic resonance imaging (MRI) with and without contrast enhancement, and spinal angiography. Progressive improvements in both spatial and contrast resolution of the nonangiographic imaging modalities during the past 20 years has cluminated in the ability of MRI to define, in exquisite fashion, the presence of abnormal vasculature and its effect on the spinal cord. The development of smaller catheters and better angiographic systems has led to superselective catheterization of paraspinal and intraspinal arteries for precise definition of the vascular abnormality. Endovascular therapy entails the deposition of liquid or particulate materials into the vascular lesion, and may be undertaken with a high degree of precision, given those technical angiographic developments. This chapter briefly reviews the normal anatomy, presents a simple classification of vascular lesions of the spine and spinal cord, describes the typical symptoms of spinal vascular lesions, and discusses the current radiographic diagnostic techniques. Examples of the major subtypes of spine and spinal cord vascular lesions are demonstrated, along with their endovascular treatment.