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Natural history and management of spinal cord arteriovenous shunts in pregnancy: A monocentric series of 10 consecutive cases with emphasis on endovascular treatment - 13/10/20

Doi : 10.1016/j.neurad.2020.09.006 
Marcus Ohlsson a, b, , Arturo Consoli b, Federico DiMaria b, Alessandro Sgreccia b, c, Georges Rodesch b
a Department of Neuroradiology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden 
b Service de Neuroradiologie Diagnostique et Thérapeutique, Hôpital Foch, Suresnes France 
c Department of Radiology, Ospedali Riuniti, Ancona, Italy 

Corresponding author at: Department of Neuroradiology, Karolinska University Hospital, Stockholm 171 76, Sweden.Department of NeuroradiologyKarolinska University HospitalStockholm171 76Sweden
Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Tuesday 13 October 2020

Graphical abstract




Management of spinal cord shunts in pregnancy:

Spinal cord arteriovenous shunts are rare but constitute a major clinical challenge when symptomatic or diagnosed during pregnancy; They are best treated by embolization after delivery and a recovery period; The results obtained show good clinical outcome without long-term rebleeds; Women with this condition should not be discouraged from becoming pregnant, however it seems wise to treat them before pregnancy to offer protection against risks during pregnancy.

Le texte complet de cet article est disponible en PDF.

Highlights

Spinal cord arteriovenous shunts are rare but constitute a major clinical challenge when symptomatic or diagnosed during pregnancy.
They are best treated by embolization after delivery and a recovery period.
The results obtained show good clinical outcome without long-term rebleeds.
Women with this condition should not be discouraged from becoming pregnant, however it seems wise to treat them before pregnancy to offer protection against risks during pregnancy.

Le texte complet de cet article est disponible en PDF.

Abstract

Purpose

Intradural spinal cord arteriovenous shunts (IDSCAVS) are rare and constitute a challenging situation if symptoms occur during pregnancy. We present a series of ten such cases referred to our center: five cervical, four thoracic and one lumbar.

Methods

We retrospectively reviewed our global series of 215 IDSCAVSs between 2002 and March 2020 and found ten patients who had presented during pregnancy. Clinical, radiological and therapeutic data were studied.

Results

Seven shunts were AVM type niduses and three were micro AV-fistulae. All were associated with pial venous reflux and six hemorrhagic cases had pseudo aneurysms. Symptoms occurred mainly during the third trimester, 80% of patients presented with hemorrhage and spinal cord dysfunction. We embolized seven patients and proposed surgery in one, always after delivery: all recovered well. One woman declined treatment; one other was operated in emergency but did not improve. Mean follow-up was 3.9 years (0.5–19 years).

Conclusions

Despite this small group of patients, our initial experience of IDSCAVSs diagnosed during pregnancy indicates that embolization is an effective management strategy if performed after delivery and a recovery period. Results indicate that IDSCAVSs seem to have a low risk of early rebleedings after the ictal event and may be closely followed up until delivery. The results obtained show good clinical outcome without long-term rebleeds. Women with known IDSCAVSs should not be discouraged from becoming pregnant, however it seems wise to embolize them before pregnancy in order to offer protection against risks during pregnancy.

Le texte complet de cet article est disponible en PDF.

Abbreviations : bAVM, IDSCAV, SCAVF, SCAVM, SCAVS, SAH

Keywords : Spinal cord arteriovenous shunts, Spinal cord AVM, Spinal cord dural fistula, Pregnancy


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