Variable anatomic configuration of the posterior spinal arteries in humans

2018 ◽  
Vol 31 (8) ◽  
pp. 1137-1143 ◽  
Author(s):  
Santiago Rojas ◽  
Marisa Ortega ◽  
Alfonso RodríGuez‐Baeza
Keyword(s):  
Posterior Spinal Arteries

Microsurgical Treatment of Recurrent Conus Medullaris Arteriovenous Malformation: 2-Dimensional Operative Video

2018 ◽  
Vol 16 (2) ◽  
pp. E44-E44
Author(s):  
M Neil Woodall ◽  
Robert F Spetzler
Keyword(s):  
Arteriovenous Malformations ◽  
Treatment Options ◽  
Conus Medullaris ◽  
Endovascular Embolization ◽  
Spinal Angiography ◽  
Microsurgical Treatment ◽  
Complete Obliteration ◽  
Retrospective Nature ◽  
Posterior Spinal Arteries

Abstract Arteriovenous malformations (AVMs) involving the conus medullaris have a unique angioarchitecture due to their involvement of the arterial basket of the conus medullaris, which represents an arterial anastomotic network between the anterior spinal artery (ASA) and posterior spinal arteries (PSAs) at the level of the conus medullaris.1 These lesions consist of a combination of a true AVM nidus, which is usually extramedullary, and direct shunts between the ASA, PSAs, and the venous system. Patients may present with radiculopathy, myelopathy, or subarachnoid hemorrhage.2 A 40-yr-old woman status post T11-L1 laminoplasty for resection of a ruptured conus AVM 6 yr prior presented with routine follow-up angiography suggestive of an arteriovenous fistula. She was counseled regarding treatment options including endovascular embolization and microsurgical ligation or resection, and she elected to proceed with surgical treatment. At the time of surgery, a recurrent AVM was noted. A 2-dimensional intraoperative video illustrates the microsurgical treatment of her recurrent conus AVM. The patient recovered well postoperatively. Spinal angiography demonstrated complete obliteration of the lesion. The patient experienced transient urinary retention that was self-limited but otherwise was without any new neurological deficit. Due to the retrospective nature of this report, informed consent was not required. Video used with permission from Barrow Neurological Institute, all rights reserved.

scholarly journals MORPHOLOGY AND MORPHOMETRIC ANALYSIS OF FORAMEN MAGNUM IN ADULT HUMAN SKULLS

2020 ◽  
Vol 8 (4.1) ◽  
pp. 7771-7776
Author(s):  
Giridhar Dasegowda ◽  
◽  
Padmalatha K ◽  
Priyanka B P ◽  
Sanjiti Mirmire ◽  
...  
Keyword(s):  
Morphometric Analysis ◽  
Transitional Zone ◽  
Foramen Magnum ◽  
Transverse Diameter ◽  
Vertebral Arteries ◽  
Important Landmark ◽  
The Mean ◽  
Posterior Spinal Arteries ◽  
Human Skulls ◽  
Base Of The Skull

Background: The Foramen magnum is an important landmark present at the base of the skull, it serves as a transitional zone between spine and skull. It is closely related to vital structures such as medulla oblongata, meninges, anterior and posterior spinal arteries, vertebral arteries and spinal accessory nerve, passing through it hence thorough knowledge of foramen magnum is required. These structures passing may undergo compression in case of foramen magnum herniation, meningiomas and foramen magnum achondroplasia. Aims: The present study aims in performing the morphometric analysis foramen magnum and to classify it based on its shape. Materials and methodology A total number of 64 adult dry human skulls were evaluated from the Department of Anatomy, ESIC MC & PGIMSR, Rajajinagar, Bengaluru, Karnataka. Results: The mean antero-posterior diameter was found to be 34.10 ± 2.63 mm, mean transverse diameter was 28.07 ± 1.87 mm, with mean area of 752.07 ± 111.97 mm2 and foramen magnum index was 1.21 ± 0.12. The foramen magnum shapes were classified as oval (30%), circle (12%), hexagonal (3%), pentagonal (5%), egg (17%), leaf (6%), irregular (27%). Conclusion: The morphometry along with other parameters can be used for sex determination in partially damaged skull bones of unknown individuals. The obtained data is useful not only for anatomists but also the neurosurgeons, otorhinolaryngologist and radiologists. Keywords: Foramen Magnum, Morphometry, Meningioma, Achondroplasia, Antero-Posterior Diameter, Transverse Diameter, Foramen Magnum Area, Foramen Magnum Index.

scholarly journals Hemodynamic Patterns of Spinal Cord Perfusion in Thoracoabdominal Aortic Aneurysm Repair

Aorta ◽  
2021 ◽  
Author(s):  
Giuseppe Rescigno ◽  
Carlo Banfi ◽  
Claudio Rossella ◽  
Stefano Nazari
Keyword(s):  
Spinal Cord ◽  
Diastolic Pressure ◽  
Aortic Surgery ◽  
Thoracoabdominal Aortic Aneurysm ◽  
Time Frame ◽  
Vascular Network ◽  
Hemodynamic Pattern ◽  
Blood Inflow ◽  
Thoracoabdominal Aortic Aneurysm Repair ◽  
Posterior Spinal Arteries

AbstractParaplegia in aortic surgery is due to its impact on spinal cord perfusion whose hemodynamic patterns (SCPHP) are not clearly defined. Detailed morphological analysis of vascular network and collateral network modifications within Monro–Kellie postulate due to the fixed theca confines was performed to identify SCPHP. SCPHP may begin with intraspinal “backflow” (I-BF), that is, hemorrhage from anterior and posterior spinal arteries, backward via the connected anterior and posterior radicular medullary arteries, through the increasing diameter and decreasing resistance of segmental arteries (SAs), off their aortic orifices outside vascular network at 0 operative field pressure. The I-BF blood bypasses both intra- and extraspinal capillary networks and causes depressurization (0 diastolic pressure) and full ischemia of dependent spinal cord. When the occlusion of those SAs orifices arrests I-BF, the hemodynamic pattern of intraspinal “steal” (I-S) may take place. The formerly I-BF blood, in fact, is now variably shared between the fraction maintained in its physiological intraspinal network and that keeping flowing as I-S through the extraspinal capillary network. I-S is, however, counteracted by the extraspinal “steal” from the connected mammary/paraspinous-independent extraspinal feeders, all physically competing for the same room left by the missed physiological SA direct aortic blood inflow. Steal phenomenon evolves within the 120-hour time frame of CNm, whose intraspinal anatomical changes may offer the physical basis within the Monro–Kelly postulate, respectively of the intraoperative and postoperative paraplegia. The current procedures could not prevent the unphysiological SCPHP but awareness of details of their various features may offer the basis for improvements tailored, to the adopted intra- and postoperative procedures.

Thrombosis of the posterior spinal arteries: A complication of an intrathecal injection of phenol

Neurology ◽  
1970 ◽  
Vol 20 (7) ◽  
pp. 659-659 ◽  
Author(s):  
J. T. Hughes
Keyword(s):  
Intrathecal Injection ◽  
Posterior Spinal Arteries

High cervical arteriovenous fistulas fed by dural and spinal arteries and draining into a single medullary vein

2014 ◽  
Vol 20 (3) ◽  
pp. 256-264 ◽  
Author(s):  
Kiyoshi Onda ◽  
Yuichi Yoshida ◽  
Kounosuke Watanabe ◽  
Hiroyuki Arai ◽  
Hideo Okada ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Surgical Intervention ◽  
Digital Subtraction ◽  
Spinal Root ◽  
Nerve Roots ◽  
Arteriovenous Fistulas ◽  
Posterior Spinal Arteries ◽  
Operative Findings ◽  
High Cervical

Object The authors previously reported a case of complex arteriovenous fistula (AVF) at C-1 with multiple dural and spinal feeders that were linked with a common medullary venous channel. The purpose of the present study was to collect similar cases and analyze their angioarchitecture to gain a better understanding of this malformation. Methods Three such cases, affecting 2 males and 1 female in their 60s who had presented with hematomyelia (2) or progressive myelopathy (1), were treated surgically, and the operative findings from all 3 cases were compared using digital subtraction angiography (DSA) to determine the angioarchitecture. Results The C-1 and C-2 radicular arteries and anterior and posterior spinal arteries supplied feeders to a single medullary draining vein in various combinations and via various routes. The drainage veins ran along the affected ventral nerve roots and lay ventral to the spinal cord. The sites of shunting to the vein were multiple: dural, along the ventral nerve root in the subarachnoid space, and on the spinal cord, showing a vascular structure typical of dural AVF, that is, a direct arteriovenous shunt near the spinal root sleeve fed by one or more dural arteries and ending in a single draining vein, except for intradural shunts fed by feeders from the spinal arteries. In 2 cases with hemorrhagic onset the drainer flowed rostrally, and in 1 case associated with congestive myelopathy the drainer flowed both rostrally and caudally. Preoperative determination of the shunt sites and feeding arteries was difficult because of complex recruitment of the feeders and multiple shunt sites. The angioarchitecture in these cases was clarified postoperatively by meticulous comparison of the DSA images and operative video. Direct surgical intervention led to a favorable outcome in all 3 cases. Conclusions A high cervical complex AVF has unique angioarchitectural characteristics different from those seen in the other spinal regions.

Ruptured Conus Medullaris Arteriovenous Malformation

2019 ◽  
pp. 297-306
Author(s):  
Michaela H. Lee ◽  
Brandon D. Liebelt ◽  
Peter Nakaji ◽  
Robert F. Spetzler
Keyword(s):  
Spinal Cord ◽  
Arteriovenous Malformation ◽  
Sexual Function ◽  
Neurological Deficit ◽  
Arteriovenous Malformations ◽  
Vascular Supply ◽  
Conus Medullaris ◽  
Proper Diagnosis ◽  
Spinal Arteriovenous Malformations ◽  
Posterior Spinal Arteries

Abstract: Conus medullaris arteriovenous malformations are an exceedingly rare cause of neurological deficit. They occupy the tip of the spinal cord and can generate motor, sensorty, bowel, bladder, or sexual function deficits. Because of the complex vascular supply of the caudal aspect of the spinal cord, which usually includes multiple feeders from both the anterior and posterior spinal arteries, management may be endovascular, microsurgical, or both. Making the proper diagnosis and distinguishing it from other similar pathologies such as arteriovenous fistula is critical. As with other spinal arteriovenous malformations, it is usually not necessary to pursue the nidus into the spinal cord parenchyma at the time of surgery. This chapter discusses the diagnosis and management of this rare disorder.

scholarly journals Microsurgical anatomy of the arterial basket of the conus medullaris

2015 ◽  
Vol 22 (6) ◽  
pp. 672-676 ◽  
Author(s):  
Nikolay L. Martirosyan ◽  
M. Yashar S. Kalani ◽  
G. Michael Lemole ◽  
Robert F. Spetzler ◽  
Mark C. Preul ◽  
...  
Keyword(s):  
Blood Supply ◽  
Vascular Malformations ◽  
Conus Medullaris ◽  
Microsurgical Anatomy ◽  
Arteriovenous Fistulas ◽  
Mean Diameter ◽  
The Mean ◽  
Posterior Spinal Arteries ◽  
The Right ◽  
Formalin Fixed

OBJECT The arterial basket of the conus medullaris (ABCM) consists of 1 or 2 arteries arising from the anterior spinal artery (ASA) and circumferentially connecting the ASA and the posterior spinal arteries (PSAs). The arterial basket can be involved in arteriovenous fistulas and arteriovenous malformations of the conus. In this article, the authors describe the microsurgical anatomy of the ABCM with emphasis on its morphometric parameters and important role in the intrinsic blood supply of the conus medullaris. METHODS The authors performed microsurgical dissections on 16 formalin-fixed human spinal cords harvested within 24 hours of death. The course, diameter, and branching angles of the arteries comprising the ABCM were then identified and measured. In addition, histological sections were obtained to identify perforating vessels arising from the ABCM. RESULTS The ASA tapers as it nears the conus medullaris (mean preconus diameter 0.7 ± 0.12 mm vs mean conus diameter 0.38 ± 0.08 mm). The ASA forms an anastomotic basket with the posterior spinal artery (PSA) via anastomotic branches. In most of the specimens (n= 13, 81.3%), bilateral arteries formed connections between the ASA and PSA. However, in the remaining specimens (n= 3, 18.7%), a unilateral right-sided anastomotic artery was identified. The mean diameter of the right ABCM branch was 0.49 ± 0.13 mm, and the mean diameter of the left branch was 0.53 ± 0.14 mm. The mean branching angles of the arteries forming the anastomotic basket were 95.9° ± 36.6° and 90° ± 34.3° for the right- and left-sided arteries, respectively. In cases of bilateral arterial anastomoses between the ASA and PSA, the mean distance between the origins of the arteries was 4.5 ± 3.3 mm. Histological analysis revealed numerous perforating vessels supplying tissue of the conus medullaris. CONCLUSIONS The ABCM is a critical anastomotic connection between the ASA and PSA, which play an important role in the intrinsic blood supply of the conus medullaris. The ABCM provides an important compensatory function in the blood supply of the spinal cord. Its involvement in conus medullaris vascular malformations makes it a critical anatomical structure.

scholarly journals Bilateral Segmental Agenesis of Carotid and Vertebral Arteries with Rete Mirabile and the Prominent Anterior and Posterior Spinal Arteries as Compensations

2014 ◽  
Vol 20 (1) ◽  
pp. 13-19 ◽  
Author(s):  
Jun Lu ◽  
Jiachun Liu ◽  
Lijun Wang ◽  
Peng Qi ◽  
Daming Wang
Keyword(s):  
Rare Case ◽  
Posterior Circulation ◽  
Anterior Spinal Artery ◽  
Vertebral Arteries ◽  
Rete Mirabile ◽  
Bilateral Carotid ◽  
Posterior Spinal Arteries ◽  
Carotid And Vertebral Arteries

Agenesis of carotid or vertebrobasilar arteries with rete formation is rare. The anterior spinal artery or posterior spinal arteries supplying the posterior circulation with steno-occlusion or agenesis of bilateral vertebral arteries is also uncommon. Here, we describe a very rare case of concomitant segmental agenesis of bilateral carotid and vertebral arteries with collateral compensations from the prominent anterior spinal artery and posterior spinal arteries, as well as some transdural arterial networks which were considered a rete mirabile. We discuss its embryological and anatomic significance.

Aneurysms of the Lateral Spinal Artery: Report of Two Cases

Neurosurgery ◽  
2001 ◽  
Vol 48 (4) ◽  
pp. 949-954 ◽  
Author(s):  
Clark C. Chen ◽  
Richard J. Bellon ◽  
Christopher S. Ogilvy ◽  
Christopher M. Putman
Keyword(s):  
Medical Records ◽  
Internal Carotid ◽  
Clinical Presentation ◽  
Treatment Options ◽  
Radiological Findings ◽  
Vertebrobasilar System ◽  
Aneurysm Resection ◽  
Collateral Pathways ◽  
Posterior Spinal Arteries ◽  
Lateral Spinal Artery

Abstract OBJECTIVE AND IMPORTANCE The goal of this report was to describe aneurysms arising from the lateral spinal artery. The locations of aneurysms contributing to subarachnoid hemorrhage (SAH) have been well characterized and are primarily in the circle of Willis or at the bifurcation points of the internal carotid artery or the vertebrobasilar system. Although the spinal arteries are also in direct communication with the subarachnoid space, aneurysms of these arteries that lead to SAH are rare. To date, only aneurysms of the anterior and posterior spinal arteries have been described. In this communication, we report two patients with aneurysms of the lateral spinal artery who presented with SAH. CLINICAL PRESENTATION Review of our neurointerventional database from 1997 to the present revealed two patients with lateral spinal artery aneurysms. The medical records, as well as the operative and radiological findings, were reviewed for both patients. In both cases, the lateral spinal arteries were involved as collateral pathways for occlusive vertebral lesions, suggesting hemodynamic stress as a cause. INTERVENTION Endovascular treatment was attempted in both cases and was successful in one; open surgery, with aneurysm resection, was performed in the other case. We review the vascular anatomic features of the spinal cord as they relate to the lateral spinal artery, as well as treatment options for lateral spinal artery aneurysms. CONCLUSION Lateral spinal artery aneurysms are a rare cause of SAH. Both endovascular and surgical treatment options are available.

scholarly journals Posterior spinal arteries

2014 ◽  
Author(s):  
Craig Hacking ◽  
Elena Trajcevska
Keyword(s):  
Posterior Spinal Arteries
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