• Toshiki Endo, Hiroaki Shimizu, Kenichi Sato, Kuniyasu Niizuma, Ryushi Kondo, Yasushi Matsumoto, Akira Takahashi, and Teiji Tominaga.
• Departments of *Neurosurgery and ‡Neuroendovascular Therapy, Tohoku University, Graduate School of Medicine; §Department of Neuroendovascular Therapy, Kohnan Hospital, Sendai, Japan.
• Neurosurgery. 2014 Sep 1;75(3):238-49; discussion 249.

BackgroundReports of cervical perimedullary arteriovenous shunt (PMAVS) are limited, and treatment strategies have not been established.ObjectiveTo describe angioarchitecture and optimal treatment strategies for cervical PMAVS.MethodsWe treated 22 patients with cervical PMAVS between 2000 and 2012 (8 women and 14 men; age, 9-80 years). According to the classification, our patients included type IVa (4 patients), type IVb (16 patients), and type IVc (2 patients). Seventeen patients presented with subarachnoid hemorrhage.ResultsA total of 41 shunting points were localized in 22 patients, of which 34 points were located ventral or ventrolateral to the spinal cord. The anterior spinal artery (ASA) contributed to the shunts in 16 patients. Aneurysm formation was identified in 8 patients. Endovascular treatment was attempted in 3 patients, resulting in complete obliteration in 1 patient (type IVc). Overall, 21 patients underwent open surgery. An anterior approach with corpectomy was elected for 2 patients; the other 19 patients underwent the posterior approaches using indocyanine green videoangiography, intraoperative angiography, endoscopy (8 patients), and neuromonitoring. Twenty patients were rated as having a good recovery at 6 months after surgery. No recurrence was observed in any patients during the follow-up (mean, 59.7 months).ConclusionShunting points of the cervical PMAVS were predominantly located ventral or ventrolateral to the spinal cord and were often fed by the ASA. Even for ventral lesions, posterior exposure assisted with neuromonitoring and endoscopy, and intraoperative angiography provided a view sufficient to understand the relationships between the shunts and the ASA and contributed to good surgical outcomes.

19 keywords...

hide…