Due to the symptoms being similar to those of other spinal disorders, such as spinal stenosis, multiple sclerosis, spinal dural arteriovenous fistula, and spinal cord tumors, diagnosing spinal arteriovenous malformations can be challenging.
- Physical examination: The healthcare provider will discuss symptoms and perform a physical examination, occasionally listening for a bruit, which is the sound of rapid blood flow caused by an AVM in arteries and veins.
- Imaging test:
- Magnetic resonance imaging (MRI): which uses strong magnets and radio waves, can generate precise pictures of the spinal cord and help identify an AVM-related tumor with irregularly linked blood vessels.
- Angiography: A tiny tube (catheter) is placed into an artery in the groin and directed to the spinal cord during an angiography. To make the blood vessels in the spinal cord visible during X-ray imaging, dye is injected into them. Angiography is utilized to locate and characterize the blood vessels responsible for the AVM.
- Ultrasound: use sound waves to create images.
The treatment for spinal AVM aims to lessen symptoms and prevent possible complications by using a combination of approaches. The choice of treatment is based on factors such as the size, location, and blood flow of the spinal AVM, the results of the neurological exam, and the patient’s overall health. The objective of the treatment is to reduce the risk of hemorrhage and halt or prevent the worsening of disability and other symptoms associated with spinal AVM.
- Medication: Painkillers may be used to ease symptoms including back pain and stiffness, but surgery may eventually be required for the majority of spinal AVMs.
- Surgery: Surgical removal is necessary to access the surrounding tissue in cases of spinal AVM. There are three different methods for removing AVMs in the spine:
- Conventional surgery: The operation involves making a skin incision to remove the AVM while ensuring that the spinal cord and adjacent structures are not damaged. Generally, surgery is performed on small AVMs located in easily accessible areas of the spinal cord.
- Endovascular embolization: Endovascular embolization is a radiologic procedure that aims to decrease the chances of hemorrhage and other complications related to spinal AVMs. A catheter is used to insert small particles of a gluelike substance into an artery in the spinal cord that is supplying blood to the AVM, which blocks the artery and reduces blood flow into the AVM but does not destroy it permanently. Doctors may suggest endovascular embolization before other types of surgery to lessen the risk of bleeding during surgery or to shrink the AVM to enhance the surgery’s efficacy.
- Radiosurgery: Involves the application of focused radiation directly to the arteriovenous malformation (AVM) to obliterate its blood vessels. Gradually, the affected blood vessels disintegrate and shut off. This technique is typically employed to manage unruptured AVMs that are small in size.
The medical team discusses the advantages and disadvantages of AVM removal surgery with the patient. Since the AVM is located close to the spinal cord, spinal AVM surgery is a technically demanding and complex procedure that should be performed only by an experienced neurosurgeon.