Spinal Arteriovenous Malformations

Introduction

Spinal Arteriovenous Malformations (AVMs) is a condition that occurs due to improper formation of veins and arteries, resulting in the entanglement of vessels. This condition is usually seen in newborns. While this condition typically impacts the brain and spinal cord, it can manifest in any body part. When appropriately diagnosed, it can be treated through surgery and many other modes of treatment, which shows promising results.

What Is Meant by Arteriovenous Malformations?

Arteriovenous malformation is where the arteries and veins get tangled like a bird's nest. These arteries usually supply blood to the brain, and the veins drain blood from the brain. This condition can affect any body part but usually affects the brain and spinal cord, called neurological arteriovenous malformations. As the brain and spinal cord comprise the CNS (central nervous system), the spinal arteriovenous malformations cause symptoms in different body parts. This condition usually affects newborns.

What Is the Cause of Spinal Arteriovenous Malformations?

This condition's exact cause is unknown, but anyone can be born with spinal arteriovenous malformation. This condition usually develops during pregnancy, and they are congenital. In sporadic cases, a person can be affected by this condition due to some head trauma or infection. In sporadic cases, AVMs are seen as a hereditary condition.

What Happens to a Person With Spinal Arteriovenous Malformation?

This condition results in harming the person in the following ways,

Bleeding:

Permanent damage can be caused due to bleeding in the surrounding tissue. When continuous bleeding occurs, it can turn out to be fatal.

Pressing or Displacement of the Anatomical Parts:

Due to the abnormal formation of the blood vessels, more blood will be present in the veins resulting in enlarged veins, which can exert pressure on the nearby tissues. This prevents oxygenation and impacts the draining function of the lymphatic system.

Tissue Death Caused by Oxygen Deprivation:

Due to the lack of capillary bridges in the affected area between the arteries and veins, oxygen and nutrients do not reach the tissues, which results in the death of the tissue and nerve cells.

Most affected people will not be aware of their being affected by this condition; it will be diagnosed only during the treatment or diagnosis of other disorders. This condition can be dangerous, whereas hemorrhage (bleeding) is more dangerous.

Which Signs and Symptoms Are Commonly Associated With Spinal Arteriovenous Malformations?

Usually, this condition does not cause any symptoms; even if they occur, they are very mild and difficult to notice. In very rare conditions, they cause severe symptoms which can impact normal functioning. Some common symptoms are:

Brain Arteriovenous Malformations:

Brain AVM is a condition that occurs when the blood vessels of the brain or those present on the brain's surface are affected. Arteriovenous malformation usually affects the brain, brainstem, and spinal cord. When brain AVM occurs, it causes bleeding in the brain, which results in stroke or brain damage. Most people with this condition have ruptured vessels in the brain as the initial symptoms.

Neurological Symptoms Caused by AVM:

• Seizure.

• The affected person will experience headaches where the duration, frequency, and severity differ from person to person.

• Weakness of muscle.

• Paralysis.

• Numbness.

• Dizziness.

• Memory, thinking, speech, movement, and balancing issues.

• Mental confusion.

The Symptoms Seen in Spinal Arteriovenous Malformations

• Sudden and severe back pain.

• Weakness of the lower body.

• Paralysis or muscle weakness in the affected areas.

AVMs can also affect areas other than the brain and spinal cord. When this occurs, the signs and symptoms experienced are:

• Breathing problems.

• Coughing blood when AVM affects the lungs.

• Pain in the abdomen.

• Black stools when AVM affects the blood vessels of the digestive system.

• Lumps in the arms and trunk.

• Pain.

• Swelling.

• Sore or ulcer.

• Weakness, numbness, and tingling sensation.

How Is Spinal Arteriovenous Malformation Diagnosed?

Initially, the doctor examines the signs and symptoms experienced by the afflicted person, and a physical examination will be performed. The doctor may monitor bruits where there will be rapid blood flow sound in the blood vessels when it is affected by AVMs. Some tests will be performed to rule out AVM conditions. These are

Imaging tests:

• MRI: Magnetic resonance imaging is used to view images of the inner body with the help of magnetic fields and computed radio waves.

• CT Scan: Computed tomography (CT) uses a combination of X-rays to view the images of the organs.

• Catheter Angiography: A small catheter tube is inserted through the groin to the region, which needs to be evaluated. This procedure uses dyes and X-rays to examine the blood vessels.

• Ultrasound: In this, the organs and vessels are viewed with the help of sound waves.

In case of suspected brain AVM, specific brain tests are performed. These are:

• Cerebral Magnetic Resonance Angiography: In this procedure, the blood vessels in the brain are seen clearly with the help of magnetic fields and radio waves.

• Computed Tomography Angiography: This procedure uses X-ray images from different angles to view the blood vessels.

• Transcranial Doppler Ultrasound: The speed of the blood flow in the brain is monitored with the help of sound waves.

How Are Spinal Arteriovenous Malformations Managed?

Each person affected by his condition is unique; the treatment changes from person to person depending on

• Type of AVM.

• Size of AVM.

• Location of AVM.

• The risk of bleeding.

• The symptoms the person experiences.

• Age.

• General health.

Any of these modes of treatment can be used,

Surgery Performed to Eliminate AVM:

During this procedure, a small incision is created at the affected area of AVM, and the surrounding arteries and veins are sealed to prevent bleeding. The AVM is carefully excised, and blood flow is directed to normal vessels.

Embolization:

A small catheter is inserted into the body to the AVM-affected region through the groin. Once it reaches the region, a glue-like substance is released, which seals the AVM and prevents the blood flow through the AVM. This procedure is recommended when the AVM is huge, and this can be performed before surgery as it helps to control bleeding during the surgical procedure. By this, the AVM can be eliminated easily with reduced risk of bleeding.

Gamma Knife Radiosurgery:

In this procedure, focused beams shrink and dissolve the AVM and help remove AVM through surgery.

Medications Used to Manage AVM Are:

• Anti-seizure medicines.

• Painkillers to manage headaches and back pain.

What Are the Complications Associated With AVM?

An untreated AVM can result in disability due to damage caused in the spinal cord and surrounding tissues which can worsen with time. Some common complications are:

• Motor problems can result in walking disabilities.

• Sensory issues like tingling sensation and numbness.

• Deformity in the spinal column.

• Aneurysm, bulging of arteries and veins.

• Tissue death can occur due to fluid accumulation and oxygen deprivation caused by elevated venous blood pressure.

• Bleeding within the brain.

Some of the AVMs can be fatal depending on the size and location they affect. Severe bleeding in the brain due to AVM can be fatal. AVM condition cannot be prevented as it is a congenital condition. But treatment can help deal with the symptoms, and surgery can help completely cure the disease.

Conclusion

AVMs are a critical medical condition that is a congenital disorder. It is caused due to entangled blood vessels, which is caused due to improper formation of arteries and veins. This condition usually is seen in the brain and the spinal cord. This condition can be treated through various modes but depends on many factors. The untreated condition can result in permanent damage. So consultation with the doctor regarding this condition may help determine what to do to manage it.