TY - JOUR
T1 - Treatment of Vascular Myelopathies
AU - Marcellino, Chris
AU - Zalewski, Nicholas L.
AU - Rabinstein, Alejandro A.
N1 - Publisher Copyright:
© 2021, The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
PY - 2021/10
Y1 - 2021/10
N2 - Purpose of review: This article reviews the treatment of vascular myelopathies of various causes, with an emphasis on the treatment and prevention of the most common non-traumatic etiologies: ischemia secondary to open and endovascular interventions for treatment of thoracoabdominal aortic aneurysms and spontaneous (non-periprocedural) spinal cord ischemia and infarction. Recent findings: Acute vascular myelopathies can present as sudden or rapid onset of paraplegia or quadriplegia. In such cases, spine MRI allows rapid and reliable exclusion of compressive or hemorrhagic lesions and may identify acute spinal cord ischemia; thus, it should be the preferred radiological technique for the evaluation of patients with suspected acute vascular myelopathy. Pressure-based protocols have improved the safety of intra- and post-procedural prophylactic and therapeutic cerebrospinal fluid drainage during thoracic aortic procedures, including open and endovascular treatment of thoracic aortic aneurysms and aortic valve replacements. Increasingly sophisticated and staged endovascular approaches to treat aortic aneurysms have greatly reduced the risk of spinal cord infarction and may not require prophylactic drainage in some cases. Spontaneous spinal cord infarction is less common, and acute treatment remains experimental. Summary: Acute myelopathies may be caused by various forms of vascular disease, and some of those causes can be treatable. Emergency MRI is often necessary to guide therapeutic interventions.
AB - Purpose of review: This article reviews the treatment of vascular myelopathies of various causes, with an emphasis on the treatment and prevention of the most common non-traumatic etiologies: ischemia secondary to open and endovascular interventions for treatment of thoracoabdominal aortic aneurysms and spontaneous (non-periprocedural) spinal cord ischemia and infarction. Recent findings: Acute vascular myelopathies can present as sudden or rapid onset of paraplegia or quadriplegia. In such cases, spine MRI allows rapid and reliable exclusion of compressive or hemorrhagic lesions and may identify acute spinal cord ischemia; thus, it should be the preferred radiological technique for the evaluation of patients with suspected acute vascular myelopathy. Pressure-based protocols have improved the safety of intra- and post-procedural prophylactic and therapeutic cerebrospinal fluid drainage during thoracic aortic procedures, including open and endovascular treatment of thoracic aortic aneurysms and aortic valve replacements. Increasingly sophisticated and staged endovascular approaches to treat aortic aneurysms have greatly reduced the risk of spinal cord infarction and may not require prophylactic drainage in some cases. Spontaneous spinal cord infarction is less common, and acute treatment remains experimental. Summary: Acute myelopathies may be caused by various forms of vascular disease, and some of those causes can be treatable. Emergency MRI is often necessary to guide therapeutic interventions.
KW - Aortic aneurysm surgery
KW - Arteriovenous fistula
KW - Epidural hematoma
KW - Infarction
KW - Spinal cord
KW - TEVAR
UR - http://www.scopus.com/inward/record.url?scp=85117329408&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85117329408&partnerID=8YFLogxK
U2 - 10.1007/s11940-021-00689-x
DO - 10.1007/s11940-021-00689-x
M3 - Review article
AN - SCOPUS:85117329408
SN - 1092-8480
VL - 23
JO - Current Treatment Options in Neurology
JF - Current Treatment Options in Neurology
IS - 10
M1 - 35
ER -