Spinal arteriovenous malformations

Last revised by Patrick O'Shea on 27 Mar 2023

Spinal arteriovenous malformations (AVMs) are characterized by arteriovenous shunting with a true nidus. They represent ~25% of spinal vascular malformations

Different types of spinal AVM (see below) have different ages of presentation, but overall 80% present between the age of 20 and 60 years 3

It is variable, ranging from progressive myelopathy (Foix-Alajouanine syndrome), often with delayed diagnosis, to catastrophic spinal subarachnoid hemorrhage (see: coup de poignard of Michon 3).

Spinal AVMs may be classified as intramedullary and extramedullary (80%) 1, and further divided into four angiographic types with additional subtypes 2,3 (for full classification see spinal vascular malformations).

Angiography remains the investigation of choice but requires meticulous technique. It is essential to remember that the site of arterial supply can be anywhere from the upper thoracic to sacral areas with little relationship to the clinical level, or visible nidus (if present).

  • T1

    • signal voids from high-velocity flow

    • dilated perimedullary vessels indent/scallop the cord 1

  • T2

    • signal voids from high-velocity flow 1

    • increased cord signal due to cytotoxic edema or myelomalacia 1

Both surgery and angioembolisation have a role in the treatment of spinal AVMs 6.

  • myelopathy from venous congestion/hypertension

  • hemorrhage: within the cord parenchyma or subarachnoid space 6

  • high-flow AVMs may cause arterial steal from adjacent spinal cord segments 6

  • myelopathy from large AVMs (rare) 6

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Cases and figures

  • Case 1: type I
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  • Case 2: type III
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  • Case 3
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  • Case 4
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  • Case 5
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