Second most common is the spinal AVM. Clinical symptoms are usually first seen from adolescence. Damage of the spinal cord is most often caused by acute intramedullary or subarachnoidal hemorrhage， venous congestion and less frequently by mass or steal effect. Spinal AVM are rather treated endovascularly than surgically or in a stepwise multidisciplinary approach.

　　Third most common is the spinal cavernous angioma. It can cause a transverse spinal cord syndrome with acute worsening by hemorrhage or mass effect. Most patients present with progressive or stepwise clinical deterioration which is thought to be due to gliosis， microthrombosis， microcirculatory changes and repeated minor bleedings into the spinal cavernous angioma. Acute and severe neurological symptoms can occur due to hemorrhage into the spinal cord. Most symptomatic or neurologically declining patients with spinal cavernous angiomas are surgical candidates.

　　Radiation therapy is still sometimes applied to spinal AVM and spinal cavernous angiomas. In our opinion it may rarely be a treatment option in few spinal AVM， but is， especially in spinal cavernous angiomas， no longer an acceptable treatment option because of the high radiation sensibility of the myelon.

　　Current optimum treatment is reached by case discussion and an individualized treatment plan，which is established by an interdisciplinary specialized neurovascular team.

　　Symptomatic treatment and rehabilitation

　　Symptomatic treatment and rehabilitation are crucial in patients with a spinal cord lesion. Depending on level and extension of the lesion， there is a risk for systemic and neurological complications， which may be life-threatening. Early intervention is necessary. Intensive care unit admittance for strict monitoring of vital signs and neurological status is necessary in patients with a cervical or a high thoracic lesion.

　　Often， patients suffer in long-term from residual deficits which are causing secondary complications including spasticity， pain， bladder， bowel and sexual dysfunction. These conditions have to be managed.

　　Specialized rehabilitation improves the chances to gain independency in everyday life.

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