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| What is a Spinal AVM? |
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A spinal AVM (arteriovenous malformation) is an abnormal collection of blood vessels in or around
the spinal cord. The walls of the vessel are often thin and dilated, and prone to rupture. This
can cause a hemorrhage (bleeding) or a stroke by stealing blood from the spinal cord. There are
three parts to the AVM: the feeding arteries, the nidus (tangle of abnormal vessels), and the
draining veins. An AVM lacks the normal capillaries (small vessels) between the arteries and the
veins.
AVMs can be small or large. They can be found anywhere along the spinal cord. Your child may have pain or a change in movement or sensation in his / her arms, legs, or both. Your child may also have loss of bowel or bladder function and acute (rapid onset) paralysis (lack of movement). |
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| How is an AVM Diagnosed? |
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To determine the location, size, and configuration of the AVM the following tests are obtained:
CT Scan A CT (computed tomography) scan is a specialized x–ray which is helpful in observing the resolution of blood in the spinal column. Sometimes a dye is used to enhance any abnormalities in the spinal column. This is called a myelogram. This procedure requires a lumbar puncture in your child’s lower back to instill the dye. Your child then receives a CT scan. MRI / MRA MRI / MRA (magnetic resonance imaging / magnetic resonance angiography) is a noninvasive test which provides a detailed picture of the spinal column, body tissue and the blood vessels. Angiogram During an angiogram, a neuroradiologist injects a dye through the femoral (groin) artery. The dye is used to enhance the AVM and obtain a detailed picture of the feeding arteries, nidus, and the draining veins. After the angiogram, your child will need to lie flat for about four hours. Children usually remain in the hospital for these four hours. This is to prevent bleeding from the femoral vessel. |
| Treatment for a Spinal AVM |
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The goal of treatment is to permanently obliterate (block) the nidus of the AVM without causing
damage to the spinal cord. However, the location and the size of the AVM will determine how it
is treated. There are two options — surgery and embolization.
Embolization Embolization is the first choice for treatment of an intradural AVM. It may also be used in combination with surgery. Embolization involves the insertion of a small catheter into the artery near the AVM. Tiny pellets or coils are inserted into the AVM’s feeder arteries. These pellets or coils block the feeding arteries allowing for the AVM to clot off or to decrease in size. Surgery Surgery to remove the AVM is only performed if the AVM is accessible and would not cause undue risk to your child. If the AVM is within the spinal cord, surgery is not possible. If surgery or embolization are indicated, the procedure is usually delayed for at least three weeks following a hemorrhage to allow the spinal cord to heal and the blood clot to reabsorb. |
| Before Surgery |
| To prepare for surgery or an embolization, your child will receive a pre–surgical work–up. This includes a health history, a physical exam, and blood tests. You will also talk with people in the Anesthesia Screening Clinic and Admissions. You will need to sign a consent form that states that you understand the risks and benefits of the surgery or embolization. Your child should have nothing to eat or drink after midnight the night before surgery. Your child will need to wash his / her back with an antibacterial soap (Hibiclens®) the night before surgery and the morning of surgery. You will receive the soap at your clinic visit. |
| After Surgery |
| After surgery, your child will go to the Pediatric Intensive Care Unit (PICU) for one night. When your child is eating and drinking, the intravenous (IV) line will be removed. If your child is not having any problems, you may go home after 3 days. |
| When to Contact your Neurosurgeon or Nurse Practitioner |
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Bermans J. Iskandar, MD
Bonnie Ohm, RN, MS |
Director of Pediatric Neurosurgery
Pediatric Nurse Practitioner |
608 263–1410
608 265–2194 |
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You should call your neurosurgeon or nurse practitioner whenever you have a question or a
concern. If you notice any of the following symptoms, please call our office.
• Fever greater than 101.5° F • Redness, pain or swelling of the skin at or near the incision site • Drainage from the incision • Irritability or extreme sleepiness • Stiff neck • Nausea and vomiting • Repeated headaches • Change in level of sensation or movement of the arms or legs • Change in bowel or bladder function • Decrease in strength |
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| Send Email to editor of this page | Last update: March 27, 2001 |