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Objective To evaluate the efficacy of embolization for spinal intramedullary arteriovenous malformations.Methods 25 patients with spinal intramedullary arteriovenous malformations (AVMs) were reviewed. Embolic therapy was conducted in 4 patients by introducing the tip of a catheter into the segmental arteries and injecting lyophilized dura or polyvinyl alcohol(PVA). Microcatheter were navigated into the feeding arteries and injected PVA in 9 patients, and NBCA in 7 patients. Embosphere was used after embolizing an aneurysm in the feeding artery with NBCA in one pateint. Results Spinal angiography immediately after embolization disclosed that the lesion were obliterated almost entirely in 12 cases and partially in others. The anterior or posterior spinal artery was preserved in all patients recently. The clinical follow-up period after embolization ranged from 6 to 60 months. 16 patients improved but four patients did not show any improvement.Conclusions Embolization appears to be the treatment of first choice in the management of juvenile or partial glomus AVMs which are not amenable to surgery.
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90%) in 57, 70%-90% in 27 cases, 50～70% in 8 cases,
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Objective To evaluate the treatment of spinal cord vascular malformations by endo vascular therapy. Methods All 41 patients including 3 cases were embolized by 3 0 silk line segments, 14 cases by selective embolization of dry dura particles, 16 by PVA and 8 cases by NBCA. Results Lesions were completely embolized in 27 cases, and partialy embolized in 14 cases. Paralysis of limbs were significantly improved in 36 cases, the other 5 cases showed no improvement on account of previous resection of the lesions. During 32 months follow up period, 18 cases recovered completely but with recurrence in 5. Conclusion Endovascular therapy is effective for spinal cord vascular malformations.
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Somatosensory evoked potential(SEP) monitoring was performed intraoperatively in 28 patients with extramedullary or intramedullary tumors.Dissection of intramedullary tumor usually leads to decrease of amplitude and increase of latency in SEP. SEP reappeared at the end of operation in 2 cases of Frankel A grade extramedullary tumors whose SEP disappeared during operation with functional recovering to some degree. In 2 cases of Frankel B and C grade intramedullary tumors, the amplitude of SEP decreased by more than 40% and the latent period in SEP increased by more than 5% during operation,and the surgical procedure was paused for a while.There was slight reversible injury of nerve post operatively. In 8 of 12 cases of Frankel D and E grade intramedullary tumors, the amplitude of SEP descended nearly by 50% and elongation of latency in SEP was about 7% during surgery. SEP was reduced lightly in other 4 cases and all achieved good recovery. Intraoperative monitoring of spinal SEP and cortex SEP can reflect the change of spinal function, reduce post operative complication, and predict prognosis.