The Historical Development of Embolization of Spinal Vascular Malformations and Classifications
World History of Neurointerventional Surgery, NOVA Publications , ss.175-188, 2025
- Yayın Türü: Kitapta Bölüm / Araştırma Kitabı
- Basım Tarihi: 2025
- Yayınevi: NOVA Publications
- Sayfa Sayıları: ss.175-188
- Anahtar Kelimeler: Arteriovenous malformation, Embolization, History, Spinal cord vascular malformation
- Sağlık Bilimleri Üniversitesi Adresli: Evet
Özet
Spinal vascular malformations (SVMs) are a diverse group of disorders characterized by abnormal blood vessel morphology, including spinal dural arteriovenous fistulas (DAVFs), spinal arteriovenous malformations (AVMs), cavernous malformations, and spinal artery aneurysms. This overview focuses on spinal AVFs and AVMs, which can lead to various forms of spinal cord dysfunction. Clinical presentations vary due to differences in pathophysiology, necessitating specific treatment approaches. The history of spinal vascular malformations reveals a challenging journey toward understanding their angioarchitecture and developing effective diagnostic and treatment methods. Initial recognition dates back to the late 19th century, with Dr. Charles Elsberg performing the first successful surgical intervention in 1914. Significant advancements were made with the introduction of spinal arteriography, enhancing the understanding of SVM pathophysiology. The development of endovascular embolization, pioneered by Doppman and colleagues, marked a significant milestone, offering a less invasive alternative to surgery. Endovascular embolization has evolved over the past 40 years, with advancements in microcatheters and embolic agents such as IBCA, NBCA, and Onyx. These innovations have improved the safety and efficacy of the procedure, allowing for better navigation of small, tortuous vasculature and controlled delivery of embolic agents. Despite these advancements, challenges remain, including the risk of spinal cord infarctions. Various classification systems for SVMs have been developed and are evolving alongside diagnostic and treatment advancements. A recent 2024 classification system emphasizes the presence or absence of retrograde flow in cortical veins, aiding in better patient management by identifying high-risk lesions. The literature on endovascular management of SVMs is limited, primarily consisting of case reports and small series, but the advancements in embolic agents and techniques hold promise for better treatment outcomes.