title: Endovascular embolization for symptomatic perimedullary AVF and intramedullary AVM: a series and a literature review.
abstract: BACKGROUND
  Perimedullary arteriovenous fistula (AVF) has shunt on the spinal cord surface and it can be treated with surgery, or endovascular embolization. Intramedullary arteriovenous malformation (AVM) has its nidus in the cord and is difficult to treat either by surgery or endovascular technique. We report our experience with endovascular embolization in the treatment of perimedullary AVF and intramedullary AVM.
  
  
  METHODS
  Four consecutive cases of spinal perimedullary AVF and six intramedullary AVM were retrospectively reviewed. These cases were evaluated and treated at Beijing Tiantan Hospital, China, over a 2-year period. A review of previously reported cases was also performed.
  
  
  RESULTS
  There was no significant difference in the presentations (P = 0.348), level of lesions (P = 0.350), arterial suppliers (P = 0.801), and associated vascular anomalies between perimedullary AVF and intramedullary AVM, except for age (P = 0.014) and treatment modalities (P = 0.003). The patients with perimedullary AVFs were younger in our cases; the age at onset of symptoms averaged 25.8 years compared to 31.7 years for intramedullary AVMs. There was a significant male predominance for both lesions, and a significantly higher incidence of subarachnoid hemorrhage than in spinal dural AVFs. Regarding treatment, endovascular coil embolization is frequently used in perimedullary AVF and liquid embolic agent is an effective therapeutic choice in intramedullary AVM.
  
  
  CONCLUSIONS
  Perimedullary AVF and intramedullary AVM are dissimilar with dural AVF in clinical characteristics. Our experience suggests that the endovascular treatment of spine perimedullary AVFs and intramedullary AVMs is feasible and effective. Endovascular treatment for intramedullary AVMs is still challenging, the main problem is acute ischemia injury of the spinal cord.
authors.affiliation: Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, No.6, Tiantan Xili, Chongwen, Beijing 100050, People's Republic of China.
authors.forename: Xianli
authors.initials: X
authors.lastname: Lv
authors.forename: Youxiang
authors.initials: Y
authors.lastname: Li
authors.forename: Xinjian
authors.initials: X
authors.lastname: Yang
authors.forename: Chuhan
authors.initials: C
authors.lastname: Jiang
authors.forename: Zhongxue
authors.initials: Z
authors.lastname: Wu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001164:Arteriovenous Fistula / Q000000981:diagnostic imaging / Q000628:therapy*; D001165:Arteriovenous Malformations / Q000000981:diagnostic imaging / Q000628:therapy*; D020785:Central Nervous System Vascular Malformations / Q000000981:diagnostic imaging / Q000628:therapy*; D002533:Cerebral Angiography; D016009:Chi-Square Distribution; D002648:Child; D004121:Dimethyl Sulfoxide / Q000627:therapeutic use; D004388:Dura Mater / Q000098:blood supply*; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011145:Polyvinyls / Q000627:therapeutic use; D015641:Radiography, Interventional; D012189:Retrospective Studies; D013116:Spinal Cord / Q000098:blood supply*; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging / Q000628:therapy; D016896:Treatment Outcome
chemical_list: C450660:Onyx copolymer; D011145:Polyvinyls; D004121:Dimethyl Sulfoxide