[Current advances in spinal vascular disease].

During treatment of spinal arteriovenous malformations (AVMs), such as dural arteriovenous fistula (AVF), perimedullary AVF, and intramedullary AVM, it is often difficult to identify the feeding artery and draining vein because of presence of multiple dilated veins in the dural space and multiple shunts. Disruption of incorrect vessels may elicit major functional deficits in the spinal cord. To avoid such complications, it is extremely important to identify the correct vessels prior to and during surgical treatment. Recently, several types of techniques have been developed for diagnosis and treatment of spinal AVMs. Although spinal AVMs must be diagnosed by digital subtraction angiography (DSA) before any surgical treatment can begin, other techniques such as CT angiography and contrasted MR angiography are valuable as a form of screening and can be useful in guiding the DSA procedure. In addition, several techniques including intraoperative angiography, dye-injection and the micro Doppler method have proven useful during the surgical procedure for understanding complex spinal vascular architectures. These approaches facilitate in the identification of feeding vessels, thereby preventing neurological deterioration due to disruption of the incorrect vessels during the surgery of spinal AVF. At the neurophysiological level, intraoperative MEP monitoring is a sensitive method for the detection of immediate motor fiber damage. Utilization of these innovative approaches will contribute to the safe and effective treatment of spinal AVMs.