Surgical Neuroangiography

In Volume 5 of Surgical Neuroangiography we will discuss indications and approaches for endovascular treatment of disorders affecting the spine and spinal cord circulations. Our approach is similar to those discussed in volume 2 and 4, it requires integration of knowledge concerning functional vascular anatomy, lesion angioarchitecture, and the relationship between normal and pathological circulations. In AVMs these features are considered as they relate to the clinical presen tation, progression, and natural history of the lesion. All these factors must then be combined with an understanding of technical capabilities to for mulate a pretherapeutic plan designed to favorably affect the long term out come in the individual patient. Endovascular surgery of spinal cord AVMs has become the treatment of choice, while microsurgery is reserved for those cases where embolization fails. Endovascular surgery may be the sole form of treatment, or may be combined with other therapeutic modalities including surgery, chemothera py, or radiation in cases of neoplasms, or may be palliative, to decrease pain or spinal cord compression. As in all other areas a multidisciplinary ap proach is essential for decision making to best accomplish the desired ob jectives.