The anterior spinal artery: The main arterial supply of the human spinal cord—a preliminary anatomic study

Abstract Purpose Angiographic techniques have gained increasing importance in suspected vascular disease of the spinal cord. This demands an advanced understanding of spinal cord blood vessel anatomy and its embryologically founded broad spectrum of variations. The aim of this study was to improve knowledge on contentious issues concerning the development of spinal cord arterial supply in higher mammals and to offer visual information of high didactic value. Methods The prenatal development was examined in cattle, using multiplanar high-resolution microangiography of injected specimens and microscopic sections. The gestational ages of the 15 specimens were between the late embryonic and the early fetal period (5–11 weeks). Microangiography of the human spinal cord from an earlier published study were used to envisage an adult arterial vascularization pattern in higher mammals. Results Establishment of the unpaired anterior spinal artery (ASA) goes through two procedures of reconfiguration until achieving its final design. Regression of the primarily established anteromedian tract is observed in cattle fetuses of 9–10 weeks. Return to the ontogenetic disposition of bilateral symmetry and a burst of vascularization from all parts of the spinal meninges follow and include the anterior median fissure as a preferred vascular pathway. Large sulcal/central arteries longitudinally anastomosing between each other emerge on both sides of the midline. The embryological pattern of exclusive peripheral medullary supply must have been converted into a combined system of predominant central (centrifugal) supply of the enlargements before a final unpaired ASA can be reconstructed. Conclusion Previous investigators focused on the early embryonic development of spinal cord arteries and missed the profound remodeling of the vascular architecture in the early fetal period.

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The arterial supply of the human spinal cord: A new approach to the arteria radicularis magna of Adamkiewicz

Acta Neurochirurgica ◽

10.1007/bf01405699 ◽

1991 ◽

Vol 109 (1-2) ◽

pp. 57-62 ◽

Cited By ~ 37

Author(s):

A. Rodriguez-Baeza ◽

A. Muset-Lara ◽

M. Rodriguez-Pazos ◽

J. M. Domenech-Mateu

Keyword(s):

Spinal Cord ◽

Arterial Supply ◽

New Approach ◽

Human Spinal Cord

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Clipping of an anterior spinal artery aneurysm using an endoscopic fluorescence imaging system for craniocervical junction epidural arteriovenous fistula: technical note

Journal of Neurosurgery Spine ◽

10.3171/2019.1.spine18983 ◽

2019 ◽

Vol 31 (2) ◽

pp. 279-284 ◽

Cited By ~ 2

Author(s):

Ahmed Mansour ◽

Toshiki Endo ◽

Tomoo Inoue ◽

Kenichi Sato ◽

Hidenori Endo ◽

...

Keyword(s):

Spinal Cord ◽

Arteriovenous Fistula ◽

Fluorescence Imaging ◽

Imaging System ◽

Artery Aneurysm ◽

Craniocervical Junction ◽

Anterior Spinal Artery ◽

Posterolateral Approach ◽

Fluorescence Imaging System ◽

Ventral Spinal Cord

The authors report the case of a 78-year-old man with a craniocervical junction epidural arteriovenous fistula who presented with subarachnoid hemorrhage from a ruptured anterior spinal artery (ASA) aneurysm. Because endovascular embolization was difficult, a posterolateral approach was chosen and a novel endoscopic fluorescence imaging system was utilized to clip the aneurysm. The fluorescence imaging system provided clear and magnified views of the ventral spinal cord simultaneously with the endoscope-integrated indocyanine green videoangiography, which helped safely obliterate the ASA aneurysm. With the aid of this novel imaging system, surgeons can appreciate and manipulate complex vascular pathologies of the ventral spinal cord through a posterolateral approach, even when the lesion is closely related to the ASA.

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Posterior approach for cervical intramedullary arteriovenous malformation with diffuse-type nidus

Journal of Neurosurgery Spine ◽

10.3171/spi.1999.91.1.0105 ◽

1999 ◽

Vol 91 (1) ◽

pp. 105-111 ◽

Cited By ~ 7

Author(s):

Kenji Ohata ◽

Toshihiro Takami ◽

Alaa El-Naggar ◽

Michiharu Morino ◽

Akimasa Nishio ◽

...

Keyword(s):

Spinal Cord ◽

Poor Prognosis ◽

Posterior Approach ◽

The Other ◽

Anterior Spinal Artery ◽

Neural Element ◽

Feeding Artery ◽

Diffuse Type ◽

Content Type ◽

Fine Print

✓ The treatment of spinal intramedullary arteriovenous malformations (AVMs) with a diffuse-type nidus that contains a neural element poses different challenges compared with a glomus-type nidus. The surgical elimination of such lesions involves the risk of spinal cord ischemia that results from coagulation of the feeding artery that, at the same time, supplies cord parenchyma. However, based on evaluation of the risks involved in performing embolization, together with the frequent occurrence of reperfusion, which necessitates frequent reembolization, the authors consider surgery to be a one-stage solution to a disease that otherwise has a very poor prognosis. Magnetic resonance (MR) imaging revealed diffuse-type intramedullary AVMs in the cervical spinal cords of three patients who subsequently underwent surgery via the posterior approach. The AVM was supplied by the anterior spinal artery in one case and by both the anterior and posterior spinal arteries in the other two cases. In all three cases, a posterior median myelotomy was performed up to the vicinity of the anterior median fissure that divided the spinal cord together with the nidus, and the feeding artery was coagulated and severed at its origin from the anterior spinal artery. In the two cases in which the posterior spinal artery fed the AVM, the feeding artery was coagulated on the dorsal surface of the spinal cord. Neurological outcome improved in one patient and deteriorated slightly to mildly in the other two patients. Postoperative angiography demonstrated complete disappearance of the AVM in all cases. Because of the extremely poor prognosis of patients with spinal intramedullary AVMs, this surgical technique for the treatment of diffuse-type AVMs provides acceptable operative outcome. Surgical intervention should be considered when managing a patient with a diffuse-type intramedullary AVM in the cervical spinal cord.

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