Spinal vascular malformations

• Vascular supply of the spinal cord is by anterior spinal artery in the median fissure and 2 posterior spinal arteries supplemented by medullary branches of intervertebral artery. The intervertebral artery gives s dural and medullary branches. The dural branches persist through life, however, the majority of medullary arteries involute and by adult life only 6-10 medullary arteries persist. The most constant of these is arteria radicularis anterior magna (Adamkiewicks artery T6-L2 more on the left side). The largest number of medullary arteries is in the cervical region. The watershed area is in the upper thoracic spinal cord between the cervical region with rich collaterals and the lower thoracic region (Adamkiewicks artery region). • The intervertebral arteries are branches of vertebral, deep cervical ascending cervical, intercostal, lumbar, median and lateral sacral arteries and all these arteries should be investigated if spinal AVM is suspected. If the MRI shows flow voids and these arteries are negative one should investigate ECA bilaterally to exclude cranial dural AVF draining into the upper spinal cord