The Quest for the Cause of Spinal Cord Ischemic Lesions: Impaired Arterial Supply or Venous Drainage?

✓The authors describe the case of a 36-year-old woman with bilateral internal jugular vein occlusion, hydrocephalus, and Dandy–Walker variant who presented with myelopathy that was ultimately attributed to ventriculoperitoneal (VP) shunt failure. Computed tomography (CT) angiography of the head and neck revealed epidural venous engorgement within the cervical spine, greater that 50% narrowing of the C2–5 spinal canal, and compression of the cervical spinal cord. After successful shunt revision, postoperative CT angiography revealed decreased venous engorgement as well as decompression of the cervical spinal cord, and the patient’s myelopathy improved. This case represents a fascinating clinical presentation of VP shunt failure, highlighting the physiological importance of the external jugular pathways involved in cerebral venous drainage.

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The antireflux mechanism – Angiographic anatomy and clinical implications

Interventional Neuroradiology ◽

10.1177/1591019920941309 ◽

2020 ◽

Vol 26 (6) ◽

pp. 691-702 ◽

Cited By ~ 1

Author(s):

Philippe Gailloud

Keyword(s):

Spinal Cord ◽

Clinical Features ◽

Venous Pressure ◽

Venous Drainage ◽

Low Flow ◽

Clinical Implications ◽

Clinical Expression ◽

Arteriovenous Fistulas ◽

Arteriovenous Shunts ◽

Retrograde Filling

Background Early anatomists suspected that the radiculomedullary veins draining the spinal cord had valves preventing their retrograde filling with anatomical casting material. Modern investigations have discarded the presence of true valves and introduced instead the notion of a pseudo-valvular configuration for which the term antireflux mechanism was coined in the 1970s. The angiographic anatomy of the antireflux mechanism has not been well documented so far. Methods This article discusses anatomical and clinical features of the antireflux mechanism with a series of 12 angiographic observations documenting the antireflux mechanism under normal and pathological circumstances. Results The antireflux mechanism divides radiculomedullary veins into intradural and extradural segments. While the structure of the antireflux mechanism is not yet fully clarified, it includes at least a tight narrowing of the radiculomedullary vein at its point of passage through the thecal sac, which is angiographically detectable and likely protects the intradural venous system from transient or persistent surges in venous pressure (e.g. sneezing, pregnancy). This tight narrowing of the antireflux mechanism likely also represents an obstacle to normal anterograde flow, potentially leading to venous stagnation and thrombosis. Conclusions The antireflux mechanism includes at least a tight narrowing of the radiculomedullary vein, which likely influences the development and clinical expression of low-flow spinal arteriovenous fistulas and might impact the spinal venous drainage even in the absence of arteriovenous shunts.

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Systemic arterial supply of the right lung with venous drainage to the pulmonary arterial circuit

Cardiology in the Young ◽

10.1017/s1047951111000783 ◽

2011 ◽

Vol 21 (6) ◽

pp. 710-712 ◽

Cited By ~ 1

Author(s):

Peter Fritsch ◽

Freyja-Maria Smolle-Juettner ◽

Andreas Gamillscheg

Keyword(s):

Pulmonary Artery ◽

Venous Drainage ◽

Left Pulmonary Artery ◽

Scimitar Syndrome ◽

Arterial Supply ◽

Respiratory Problems ◽

Right Pulmonary Artery ◽

Pulmonary Arterial ◽

The Right ◽

Systemic Arterial Supply

AbstractIn a girl suffering from “Scimitar syndrome”, a rerouting of the scimitar vein was performed at the age of 6 years, but no embolisation of the aberrant systemic vessel was done. She presented with recurring respiratory problems 13 years later. An angiography revealed an invert flow from the aberrant systemic vessel via the right pulmonary artery into the left pulmonary artery. After pneumonectomy, she recovered well.

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Resection of spinal hemangioblastoma

Neurosurgical FOCUS ◽

10.3171/2014.v3.focus14379 ◽

2014 ◽

Vol 37 (v2supplement) ◽

pp. Video15

Author(s):

Giuseppe Lanzino ◽

Saul F. Morales-Valero ◽

William E. Krauss

Keyword(s):

Spinal Cord ◽

Venous Drainage ◽

Complete Resection ◽

Cervical Cord ◽

Von Hippel Lindau ◽

Link Type ◽

Single Piece ◽

Von Hippel Lindau Disease ◽

Spinal Hemangioblastoma

Spinal cord hemangioblastomas occur as sporadic lesions or in the setting of Von Hippel-Lindau disease. In this intraoperative video we present a case of sporadic cervical cord hemangioblastoma and illustrate the main surgical steps to achieve safe and complete resection which include: identification and division of the feeding arteries; careful circumferential dissection of the tumor from the surrounding gliotic cord; identification, isolation and division of the main venous drainage and single piece removal of the tumor.The video can be found here: http://youtu.be/I7DxqRrfTxc.

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Venous drainage of the spine and spinal cord: A comprehensive review of its history, embryology, anatomy, physiology, and pathology

Clinical Anatomy ◽

10.1002/ca.22354 ◽

2014 ◽

Vol 28 (1) ◽

pp. 75-87 ◽

Cited By ~ 40

Author(s):

Christoph J. Griessenauer ◽

Joel Raborn ◽

Paul Foreman ◽

Mohammadali M. Shoja ◽

Marios Loukas ◽

...

Keyword(s):

Spinal Cord ◽

Venous Drainage ◽

Comprehensive Review

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THE ARTERIAL SUPPLY AND VENOUS DRAINAGE OF THE HUMAN HYPOPHYSIS CEREBRI

Quarterly Journal of Experimental Physiology and Cognate Medical Sciences ◽

10.1113/expphysiol.1954.sp001072 ◽

1954 ◽

Vol 39 (3) ◽

pp. 199-217 ◽

Cited By ~ 75

Author(s):

G. P. Xuereb ◽

Marjorie M. L. Prichard ◽

P. M. Daniel

Keyword(s):

Venous Drainage ◽

Arterial Supply

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Variants of radiculomeningeal vascular malformations of the spine

Journal of Neurosurgery ◽

10.3171/jns.1987.66.3.0333 ◽

1987 ◽

Vol 66 (3) ◽

pp. 333-337 ◽

Cited By ~ 51

Author(s):

Leslie D. Cahan ◽

Randall T. Higashida ◽

Van V. Halbach ◽

Grant B. Hieshima

Keyword(s):

Spinal Cord ◽

Vascular Malformations ◽

Venous Pressure ◽

Venous Drainage ◽

Venous System ◽

Low Flow ◽

Neurological Deficits ◽

Content Type ◽

Dorsal Nerve ◽

Intraspinal Hemorrhage

✓ In recent years, it has become evident that the most common form of arteriovenous malformation to involve the spinal cord in adults is a low-flow fistula with its nidus located on the dura in relation to the dorsal nerve root. This lesion, termed “radiculomeningeal fistula” (RMF), is drained by the intradural coronal venous system and most likely causes neurological deficits due to raised venous pressure within the spinal cord. The therapy that was formerly recommended was multilevel laminectomy with microsurgical stripping of the intradural vessels. However, that procedure focused on the draining veins rather than the nidus, and it has been replaced by direct treatment of the nidus or by disconnecting the nidus from the coronal venous system. This paper reports variants of RMF's that show a wider spectrum of the clinical and radiological findings than has been previously reported. Three patients presenting with extradural venous drainage, intraspinal hemorrhage, and/or sudden non-hemorrhagic neurological decline are reported. A more complete understanding of RMF facilitates the radiological and clinical evaluation of these patients and enables the surgeon to modify the therapy in a significant way.

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The arterial supply to the lumbo-sacral spinal cord in the monkey: A comparison with man

The Anatomical Record ◽

10.1002/ar.1091780105 ◽

1974 ◽

Vol 178 (1) ◽

pp. 41-48 ◽

Cited By ~ 5

Author(s):

Larry C. Fried ◽

John Doppman

Keyword(s):

Spinal Cord ◽

Arterial Supply ◽

Sacral Spinal Cord

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Microsurgical Technique for Treatment of Perimedullary Spinal Arteriovenous Fistulae: 2-Dimensional Operative Video

Operative Neurosurgery ◽

10.1093/ons/opz277 ◽

2019 ◽

Vol 19 (1) ◽

pp. E65-E65

Author(s):

Brian M Howard ◽

Daniel L Barrow

Keyword(s):

Spinal Cord ◽

Cervical Spinal Cord ◽

Venous Drainage ◽

Endovascular Embolization ◽

Acute Onset ◽

Bladder Function ◽

Venous Anatomy ◽

Intraoperative Angiography ◽

Thyrocervical Trunk ◽

Upper Thoracic

Abstract The case is of a 49-yr-old female admitted after acute onset lower cervical/upper thoracic region pain with left hemi-body hypoesthesia below the C7 level. Magnetic resonance imaging showed a spinal cord intraparenchymal hemorrhage at the C6/7 levels. Physical exam revealed hypoesthesia on the left from C7 and below with associated 3/5 wrist and finger extensor and 4/5 triceps strength on the left. The remainder of the neurological exam was normal including lower extremity strength and bowel/bladder function. A craniocervical angiogram showed a perimedullary arteriovenous fistula on the left, ventrolateral aspect of the spinal cord with a single feeding artery that originated from the thyrocervical trunk and entered through the left C6 nerve root sleeve. Venous drainage was cephalad to cortical cerebellar veins and to the suboccipital plexus. A branch of the thyrocervical trunk supplying the ventral spinal cord originated close to the fistula, which precluded endovascular embolization. The patient underwent C6-T1 laminectomies for microsurgical treatment of the fistula. This case demonstrates multiple key concepts in the surgical management of these rare lesions as follows: the ventral aspect of the cervical spinal cord can be safely approached from posterior. The venous anatomy is often confusing and intraoperative angiography utilizing both indocyanine green and conventional digital subtraction techniques are of paramount importance. Unlike arteriovenous malformations, the venous drainage can be pruned to gain visualization and trace the venous anatomy retrograde to the point of the fistula. The patient awoke from surgery at her neurological baseline. The patient consented to de-identified publication of this case.

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