Angiographic management of angiomatous malformations in the central nervous system

Angiomatous malformations of the central nervous system are relatively rare and have a serious prognosis. Clinical manifestations of such lesions of the spine include back pain associated with motor and sensory weakness, progressing to complete paraplegia. In angiomatous involvement of the brain, the symptoms may progress from headaches to coma and death. Computerized tomography and magnetic resonance imaging are new noninvasive modalities used in the diagnosis of such malformation, but they have not replaced myelography and angiography. Up to the past decade, the management of angiomatous lesions of the CNS was only surgical. Angiographic embolization is now widely accepted as an alternate method of management. Experience with embolic treatment of 3 cases is reported. In a 15-year-old boy with two adjacent thoracic vertebral hemangiomas (D7 and D8) compressing the spinal cord, embolization was used before surgery. A 23-year-old man with acute myelopathy due to extraretro-medullary arteriovenous malformations of the spinal cord (D9-D11) was successfully treated by selective embolization via catheter of the right 10th intercostal feeding vessel. An 82-year-old man had proptosis, bruit and pulsation in the right eyeball and loss of vision. Arteriovenous malformation of the dura of the anterior cranial fossa was demonstrated and was completely cured by bilateral selective embolization of the feeding branches of the internal maxillary arteries.