LAUSR

Spinal vascular lesions are rare and intriguing clinical entities. Over the past several decades, the combined expertise of our specialty has allowed important headway to be made in the diagnosis and management of these lesions. A new classification system is proposed that stratifies these lesions into neoplastic vs arteriovenous lesions. Neoplastic lesions comprised hemangioblastomas (true 3 cell line lesions) and cavernous malformations (single cell line lesions)1; arteriovenous lesions include fistulas and arteriovenous malformations. Among the neoplastic lesions, hemangioblastomas can be sporadic or occur as part of familial syndromes. Their removal is usually relatively straightforward, and surgery is tailored to their location within the spinal cord. Cavernous malformations may also occur sporadically or familially, and they can appear throughout the spinal cord. Surgical resection generally involves 1 of 3 approaches: a midline myelotomy, entry through the substantia gelatinosa or dorsal root entry zone, or a lateral approach between the nerve roots at the level of the dentate ligaments. Spinal cord arteriovenous lesions may be either fistulas or malformations.1 Fistulas may be either extradural or intradural, and intradural lesions may be either dorsal or ventral. Similarly, spinal cord arteriovenous malformations are either extradural or intradural, with intradural lesions further classified as either central or lateral intramedullary lesions or conus lesions (Figure 1). We classify these latter categories below and offer accumulated pearls for their surgical management.