Angiographie Demonstration and Nonsurgical Embolization of Spinal Cord Angioma

The value of arteriography in the diagnosis of angioma of the spinal cord has been stressed recently (3–11). This technic permits an exact definition of the position and extent of the malformation as well as of the location of its afferent and efferent vessels. The demonstration of the feeding vessels also allows a more logical approach to therapy. Before the advent of arteriography, angiomas of the spinal cord were usually treated by laminectomy with decompression alone, or by laminectomy combined with local excision or coagulation of the malformation. The results of these surgical efforts were often disappointing and were frequently associated with a deterioration in the neurologic state of the patient. More recently, ligation of the feeding arteries has been recommended (3, 5, 9). This surgical management has improved the neurologic deficit markedly in many instances and, at least, has not worsened it.

Nonsurgical embolization of arteriovenous malformations of the spinal cord has not been proposed previously. A patient with such a malformation of the thoracolumbar cord, angiographically demonstrated and successfully treated by nonsurgical embolization, is presented.

In 1962, at the age of twenty-two years, this man was first admitted to the University of California Medical Center, complaining of sudden severe pain in the left hip and low back, associated with weakness of the left leg. He stated that at the age of twelve years he had “polio,” which consisted of an abrupt onset of pain in the back and neck and associated clonic movements of the feet. He recovered, but a slight weakness of the right thigh and calf muscles remained. Since the age of sixteen years he had had intermittent episodes of low back pain aggravated by motion and coughing.

Examination revealed slight shortening of the right leg, marked weakness of both lower extremities, and bilateral ankle clonus. Persistent tonic contractions of the thigh muscles were noted, and there was marked hypesthesia along the lateral aspects of both calves and the dorsal aspect of the feet. Position sense was impaired in the toes. On lumbar puncture, fluid with a faint tinge of pink was obtained with an opening pressure of 170 mm. A myelogram showed a partial block at the level of the first lumbar vertebra with irregular filling defects in the Pantopaque column, extending cranially from the second lumbar vertebra over several segments. Thoracolumbar laminectomy revealed an extensive arteriovenous malformation that appeared not only to lie on the dorsal surface of the cord, but to actually penetrate its substance. It was considered inoperable. The patient recovered gradually and on discharge was able to walk with a foot support.

In 1965 and again in April 1966 similar attacks of severe back pain recurred, associated with marked weakness of the legs, from which the patient partially recovered.