Endovascular management of spinal arteriovenous malformations: Report of four cases and literature review.

Background: Spinal arteriovenous malformations (AVMs) are rare vascular lesions of the central nervous system that may lead to progressive myelopathy or acute neurological decline. Early diagnosis remains challenging due to the nonspecific nature of symptoms and limitations in imaging. Case Description: We present a series of four cases of AVMs treated with endovascular embolization. Patients ranged in age from 19 to 65 years and presented with various symptoms, including tetraparesis, progressive spastic paraparesis, and acute paraplegia. Malformations included type II (glomus), type III (juvenile), and a complex medullary-bulbar AVM associated with cerebellar hemangioblastomas. Embolization was performed using ethylene-vinyl alcohol copolymer with or without functional balloon occlusion testing. In one case, hemorrhage prompted surgical decompression following embolization - another required staged endovascular treatment for a prenidal aneurysm. Outcomes included partial improvement in motor and sensory symptoms, with persistent deficits in severe cases. Conclusion: Endovascular therapy, a proven and often preferred option for managing AVMs, especially in cases where surgical access is limited or high-risk, has demonstrated significant effectiveness. While complete obliteration is not always achievable, reducing flow and nidus volume can significantly improve symptoms and decrease the risk of hemorrhage. Multidisciplinary planning and individualized treatment are essential for optimal outcomes.