Management of Endovascular Intervention Complication in Spinal Vascular Malformation—Report of Two Cases

JOURNAL TITLE: The Journal of Spinal Surgery

Author
1. Indiradevi Bhagavatula
2. Amit Padwal
3. Manish Beniwal
ISSN
2349-0462
DOI
10.5005/jp-journals-10039-1210
Volume
6
Issue
2
Publishing Year
2019
Pages
4
Author Affiliations
    1. Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
    1. Department of Neurosurgery National Institute of Mental Health and Neurosciences Bengaluru, Karnataka, India
    1. Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
  • Article keywords
    Complication, Intervention, Laminectomy, NBCA, Onyx

    Abstract

    Aim: Management of cases of spinal vascular malformation, complicated by vessel injury during catheterization. Background: Vascular abnormalities of the spinal cord are rare group of spinal cord disease and complex angioarchitecture of these lesions makes its treatment both by surgical or radiological intervention technically demanding. Case description: We report two cases of spinal vascular malformation, complicated by vessel injury during catheterization. In case 1, extravasation of embolic material and blood could be documented by the digital subtraction angiogram (DSA), the patient developed progressive sensorimotor deficits after the next 48 hours, whereas in case 2, the patient developed immediate postprocedural weakness in both lower limbs and postprocedural computed tomography (CT) showed glue material in the spinal canal. Both the patients underwent decompressive laminectomy and showed improvement in motor power. Conclusion: Following intervention, if the patient develops weakness, it is generally thought to be due to ischemia, and not due to extravasated material (glue + hematoma). When imaging shows the mass effect due to this complication, the patient should undergo decompression instead of taking a pessimistic attitude of not doing anything due to supposedly arterial ischemia and infarct.

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