{
  "abstract": "Background Spinal vascular malformations (SVMs) are rare but potentially disabling lesions characterized by abnormal arteriovenous shunts leading to progressive venous congestive myelopathy or, less commonly, hemorrhage. Delayed diagnosis remains a major determinant of irreversible neurological decline. We aimed to analyze the clinical presentation, angioarchitectural features, treatment strategies, and functional outcomes of patients treated at a tertiary referral center in Argentina.Methods We performed a retrospective observational study of 41 consecutive patients with angiographically confirmed spinal vascular malformations. Lesions were classified according to the Takai system. Baseline and follow-up neurological status were assessed using the Aminoff-Logue Scale (ALS), evaluating gait and micturition subscores. All patients underwent spinal MRI and selective digital subtraction angiography (DSA). Treatment modality—primarily endovascular—was individualized based on lesion subtype, arterial supply, and safety considerations. Functional outcomes were assessed at approximately 3 months and at final follow-up.Results The mean age was 56.9 ± 14.3 years, with male predominance (68%). Perimedullary fistulas (type IV) were most frequent, followed by dural fistulas (type I). Thoracic localization predominated (58%). The vast majority (97.5%) presented with progressive ischemic myelopathy; hemorrhagic onset occurred in one case. Clinically, progressive paraparesis, pyramidal signs, sensory disturbances, and sphincter dysfunction were characteristic features. Angioarchitecture demonstrated marked heterogeneity, with radiculomedullary and intercostal arteries (D6-D12) representing the most common feeders. Cyanoacrylate-based embolic agents (NBCA and derivatives) were the primary treatment modality. Endovascular therapy achieved effective shunt obliteration in the majority of cases. Functionally, ALS gait scores demonstrated significant early improvement at 3 months, which was maintained at final follow-up. In contrast, micturition recovery was slower and less complete, with gradual improvement over time. This dissociation reflects differential reversibility of motor versus autonomic pathways after chronic venous congestion. One patient with severe hemorrhagic presentation died despite technically successful treatment.Conclusion In this Argentine cohort, spinal vascular malformations predominantly presented as progressive ischemic myelopathy driven by venous hypertension. Thoracic localization and male predominance were common. Endovascular treatment—particularly with cyanoacrylate-based embolization achieving venous penetration—resulted in durable neurological stabilization and meaningful motor recovery. However, delayed presentation remains associated with incomplete sphincter recovery. Early recognition and definitive interruption of intradural venous drainage remain the most critical modifiable factors for optimizing long-term functional outcomes.Disclosures A. Maidan: None.",
  "authors": [
    {
      "affiliations": [
        "Instituto Médico ENERI, Clínica La Sagrada Familia, Buenos Aires, Argentina"
      ],
      "name": "A Maidan"
    },
    {
      "affiliations": [
        "Insituto Medico ENERI-Clinica La Sagrada Familia, Bs As, Argentina"
      ],
      "name": "I Lylyk"
    },
    {
      "affiliations": [
        "Argentina"
      ],
      "name": "P Lylyk"
    },
    {
      "affiliations": [
        "Eneri-Clinica Adventista Belgrano, Belgrano, Argentina"
      ],
      "name": "P Lylyk"
    }
  ],
  "title": "E-203 Spinal vascular malformations: clinical characteristics, angioarchitecture, and outcomes in an argentine cohort",
  "uid": "bcaecec3-b3a7-50e1-8943-a88c539a5519"
}