Transthoracic Approach to an Intramedullary Vascular Malformation of the Thoracic Spinal Cord

Abstract A transthoracic approach with resection of a vertebral body was used to obtain access to an intramedullary vascular malformation of the thoracic spinal cord. The malformation consisted of three discrete intramedullary tufts of vessels fed by an abnormal branch of the anterior spinal artery arising from the T-9 intercostal artery. Although the abnormal branch of the anterior spinal artery did not appear to supply normal cord, the patient developed transient weakness postoperatively after occlusion of this artery. Follow-up angiography showed that one part of the malformation was still present and was fed by the T-6 intercostal artery.

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Transthoracic approach to an intramedullary vascular malformation of the thoracic spinal cord

Neurosurgery ◽

10.1097/00006123-198205000-00016 ◽

1982 ◽

Vol 10 (5) ◽

pp. 631???4 ◽

Cited By ~ 1

Author(s):

R B Raynor ◽

R Weiner

Keyword(s):

Spinal Cord ◽

Vascular Malformation ◽

Transthoracic Approach ◽

Thoracic Spinal Cord ◽

Thoracic Spinal

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Tissue bridges predict recovery after traumatic and ischemic thoracic spinal cord injury

Neurology ◽

10.1212/wnl.0000000000008318 ◽

2019 ◽

Vol 93 (16) ◽

pp. e1550-e1560 ◽

Cited By ~ 5

Author(s):

Dario Pfyffer ◽

Eveline Huber ◽

Reto Sutter ◽

Armin Curt ◽

Patrick Freund

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Clinical Status ◽

Lesion Length ◽

Lesion Area ◽

Thoracic Spinal Cord ◽

Thoracic Spinal ◽

Cord Injury ◽

Cystic Cavity

ObjectiveTo investigate the spatiotemporal evolution and predictive properties of intramedullary damage and midsagittal tissue bridges at the epicenter of a thoracic spinal cord injury (SCI) using MRI.MethodsWe retrospectively assessed midsagittal T2-weighted scans from 25 patients with thoracic SCI (14 traumatic, 11 ischemic) at 1 month post-SCI. In 12 patients with SCI, linear mixed-effects models on serial MRI explored temporal trajectories of quantifiable lesion markers (area, length, and width) and tissue bridges. Using partial correlation analysis, we assessed associations between structural lesion characteristics at 1 month post-SCI and recovery at 1 year postinjury, adjusting for baseline clinical status, age, and sex.ResultsLesion area decreased by 5.68 mm2 (p = 0.005), lesion length by 2.14 mm (p = 0.004), and lesion width by 0.13 mm (p = 0.004) per month. Width of tissue bridges increased by 0.06 mm (p = 0.019) per month, being similar in traumatic and ischemic SCI (p = 0.576). Smaller lesion area, length, width, and wider tissue bridges at 1 month post-SCI predicted better recovery at 1-year follow-up.ConclusionsOver time, the immediate area of cord damage shrunk while the cystic cavity became demarcated. Adjacent to the cyst, midsagittal tissue bridges became visible. The width of tissue bridges at 1 month post-SCI predicted recovery at 1 year follow-up. Measures of lesion area and tissue bridges early after traumatic and ischemic thoracic SCI therefore allow characterizing the evolution of focal cord damage and are predictive of recovery in thoracic SCI. Thus, lesion extent and tissue bridges hold potential to improve diagnosis and patient stratification in interventional trials.

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Microangioarchitecture of the feline spinal cord

Journal of Neurosurgery ◽

10.3171/jns.1987.66.3.0447 ◽

1987 ◽

Vol 66 (3) ◽

pp. 447-452 ◽

Cited By ~ 15

Author(s):

Yutaka Naka ◽

Toru Itakura ◽

Kunio Nakai ◽

Kazuo Nakakita ◽

Harumichi Imai ◽

...

Keyword(s):

Spinal Cord ◽

Dorsal Surface ◽

Ventral Surface ◽

Anterior Spinal Artery ◽

Corrosion Casts ◽

Thoracic Spinal Cord ◽

Content Type ◽

Thoracic Spinal ◽

Fine Print ◽

Anterior Median

✓ The microangioarchitecture of corrosion casts of the cat spinal cord was studied by scanning electron microscopy. On the ventral surface of the spinal cord, the anterior spinal artery and the anterior spinal vein ran parallel along the anterior median fissure. Many central arteries branching from the anterior spinal artery coursed in a wavelike manner in the anterior median fissure. The number of central arteries was lowest in the thoracic spinal cord. Central arteries at some spinal cord levels revealed well-developed anastomoses with other central arteries in the anterior median fissure. These well-developed anastomotic central arteries were frequently observed in the thoracic spinal cord, in which the number of central arteries was lowest. On the dorsal surface of the spinal cord, the posterior spinal vein ran longitudinally at the midline and was drained by circumferential veins and posterior central veins. This vein formed a characteristic anastomotic plexus. Small arterioles (20 µm in diameter) in the spinal parenchyma revealed a ring-like compression at the branching site.

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Aminergic and cholinergic innervations of the spinal cord blood vessels of cats

Journal of Neurosurgery ◽

10.3171/jns.1983.58.6.0900 ◽

1983 ◽

Vol 58 (6) ◽

pp. 900-905 ◽

Cited By ~ 28

Author(s):

Toru Itakura

Keyword(s):

Spinal Cord ◽

Cord Blood ◽

Blood Vessels ◽

Nerve Fibers ◽

Anterior Spinal Artery ◽

Thoracic Spinal Cord ◽

Cholinergic Nerve ◽

Ischemic Change ◽

Thoracic Spinal ◽

Cholinergic Nerve Fibers

✓ The distribution patterns of aminergic and cholinergic nerve fibers in the feline spinal cord blood vessels were studied by means of amine histofluorescence and acetylcholinesterase (AChE) staining. These patterns were compared with those of the cerebral blood vessels. The anterior spinal artery had a dense network of aminergic and AChE-positive (probably cholinergic) nerve fibers. The posterior spinal vein, in contrast, exhibited only aminergic nerve fibers. Small intraparenchymal blood vessels in the spinal cord also had strongly fluorescent (probably peripheral) aminergic nerve fibers, as well as pial spinal blood vessels. This was a characteristic feature in the spinal cord. The distribution pattern and the density of these two sorts of nerve fibers in the anterior spinal artery varied widely with the individual segment of the spinal cord. The thoracic spinal cord had the lowest number of these nerve fibers of any part of the spinal cord. This fact may explain why the thoracic spinal cord is most susceptible to ischemic change.

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Combined medical and surgical treatment after acute spinal cord injury: results of a prospective pilot study to assess the merits of aggressive medical resuscitation and blood pressure management

Neurosurgical FOCUS ◽

10.3171/foc.1999.6.1.7 ◽

1999 ◽

Vol 6 (1) ◽

pp. E6 ◽

Cited By ~ 1

Author(s):

Fernando L. Vale ◽

Jennifer Burns ◽

Amie B. Jackson ◽

Mark N. Hadley

Keyword(s):

Blood Pressure ◽

Spinal Cord ◽

Spinal Cord Injuries ◽

Cervical Spinal Cord ◽

Bladder Function ◽

Thoracic Spinal Cord ◽

Arterial Blood ◽

Thoracic Spinal ◽

Cord Injury

The optimal management of acute spinal cord injuries remains to be defined. The authors prospectively applied resuscitation principles of volume expansion and blood pressure maintenance to 77 patients who presented with acute neurological deficits as a result of spinal cord injuries occurring from C-1 through T-12 in an effort to maintain spinal cord blood flow and prevent secondary injury. According to the Intensive Care Unit protocol, all patients were managed by Swan-Ganz and arterial blood pressure catheters and were treated with immobilization and fracture reduction as indicated. Intravenous fluids, colloid, and vasopressors were administered as necessary to maintain mean arterial blood pressure above 85 mm Hg. Surgery was performed for decompression and stabilization, and fusion in selected cases. Sixty-four patients have been followed at least 12 months postinjury by means of detailed neurological assessments and functional ability evaluations. Sixty percent of patients with complete cervical spinal cord injuries improved at least one Frankel or American Spinal Injury Association (ASIA) grade at the last follow-up review. Thirty percent regained the ability to walk and 20% had return of bladder function 1 year postinjury. Thirty-three percent of the patients with complete thoracic spinal cord injuries improved at least one Frankel or ASIA grade. Approximately 10% of the patients regained the ability to walk and had return of bladder function. As of the 12-month follow-up review, 92% of patients demonstrated clinical improvement after sustaining incomplete cervical spinal cord injuries compared to their initial neurological status. Ninety-two percent regained the ability to walk and 88% regained bladder function. Eighty-eight percent of patients with incomplete thoracic spinal cord injuries demonstrated significant improvements in neurological function 1 year postinjury. Eighty-eight percent were able to walk and 63% had return of bladder function. The authors conclude that the enhanced neurological outcome that was observed in patients after spinal cord injury in this study was in addition to, and/or distinct from, any potential benefit provided by surgery. Early and aggressive medical management (volume resuscitation and blood pressure augmentation) of patients with acute spinal cord injuries optimizes the potential for neurological recovery after sustaining trauma.

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Spontaneous Thoracic Spinal Cord Herniation: Three Cases with Long-term Follow-up

Neurosurgery ◽

10.1227/01.neu.0000180016.69507.e0 ◽

2005 ◽

Vol 57 (5) ◽

pp. E1067-E1067 ◽

Cited By ~ 29

Author(s):

Kevin N. Ammar ◽

Patrick R. Pritchard ◽

Paul G. Matz ◽

Mark N. Hadley

Keyword(s):

Spinal Cord ◽

Thoracic Spinal Cord ◽

Thoracic Spinal ◽

Spinal Cord Herniation ◽

Long Term Follow Up

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Progressive motor impairment from a critically located lesion in highly restricted CNS-demyelinating disease

Multiple Sclerosis Journal ◽

10.1177/1352458518781979 ◽

2018 ◽

Vol 24 (11) ◽

pp. 1445-1452 ◽

Cited By ~ 11

Author(s):

B Mark Keegan ◽

Timothy J Kaufmann ◽

Brian G Weinshenker ◽

Orhun H Kantarci ◽

William F Schmalstieg ◽

...

Keyword(s):

Spinal Cord ◽

Demyelinating Disease ◽

Cervical Spinal Cord ◽

Motor Impairment ◽

Subcortical White Matter ◽

Thoracic Spinal Cord ◽

Thoracic Spinal ◽

Demyelinating Lesions ◽

Magnetic Resonance Imaging Mri

Objective: To report progressive motor impairment from a critically located central nervous system (CNS) demyelinating lesion in patients with restricted magnetic resonance imaging (MRI)-lesion burden. Methods: We identified 38 patients with progressive upper motor-neuron impairment for >1 year, 2–5 MRI CNS-demyelinating lesions, with one seemingly anatomically responsible for progressive motor impairment. Patients with any alternative etiology for progressive motor impairment were excluded. A neuroradiologist blinded to clinical evaluation reviewed multiple brain and spinal-cord MRI, selecting a candidate critically located demyelinating lesion. Lesion characteristics were determined and subsequently compared with clinical course. Results: Median onset age was 47.5 years (24–64); 23 (61%) women. Median follow-up was 94 months (18–442); median Expanded Disability Status Scale Score (EDSS) at last follow-up was 4.5 (2–10). Clinical presentations were progressive: hemiparesis/monoparesis 31; quadriparesis 5; and paraparesis 2; 27 patients had progression from onset; 11 progression post-relapse. Total MRI lesions were 2 ( n = 8), 3 ( n = 12), 4 ( n = 12), and 5 ( n = 6). Critical lesions were located on corticospinal tracts, chronically atrophic in 26/38 (68%) and involved cervical spinal cord in 27, cervicomedullary/brainstem region in 6, thoracic spinal cord in 4, and subcortical white matter in 1. Conclusion: Progressive motor impairment may ascribe to a critically located CNS-demyelinating lesion in patients with highly restricted MRI burden. Motor progression from a specific demyelinating lesion has implications for understanding multiple sclerosis (MS) progression.

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Nondysraphic pediatric intramedullary spinal cord lipomas

Journal of Neurosurgery Pediatrics ◽

10.3171/2009.9.peds09238 ◽

2010 ◽

Vol 5 (2) ◽

pp. 172-178 ◽

Cited By ~ 10

Author(s):

Karen L. Fleming ◽

Laurence Davidson ◽

Ignacio Gonzalez-Gomez ◽

J. Gordon McComb

Keyword(s):

Spinal Cord ◽

Los Angeles ◽

Retrospective Chart Review ◽

Thoracic Spinal Cord ◽

Intramedullary Spinal Cord ◽

Institutional Review ◽

Thoracic Spinal ◽

Stabilization Procedure

Object Intramedullary spinal cord lipomas not associated with dysraphism are infrequently reported. When present, they typically occur in children and have a predilection for the cervical and thoracic spinal cord. The authors review the presentation, treatment, and disease course in 5 pediatric patients, and compare the outcomes with previously reported cases. Methods With institutional review board approval, a retrospective chart review was undertaken at Childrens Hospital Los Angeles. Results Four patients with intramedullary spinal cord lipomas and 1 patient with a lipoblastoma, none associated with dysraphism, were retrospectively reviewed. There were 2 boys and 3 girls ranging in age from 2 months to 4 years. Four patients underwent a laminectomy or laminoplasty with one or more subtotal resections. One patient initially underwent a decompressive laminoplasty without debulking. The median follow-up was 8 years (range 12 months–11 years). Two patients had regrowth of their lipoma, necessitating a second surgery in one patient and 3 debulking surgeries in the other. Postoperatively, 3 patients developed mild kyphosis, none significant enough to require orthopedic intervention. One patient underwent a stabilization procedure at the time of the initial laminectomy and tumor debulking. No patient received chemotherapy or radiation. At the most recent follow-up visit, patients demonstrated improved neurological function when compared with preoperative status. Conclusions In addition to a decompressive laminectomy, debulking of the lipoma provides the best long-term neurological outcome. Gross-total excision is not warranted and usually is not possible. Long-term follow-up is needed, and repeat debulking of the lipoma is indicated if there is an increase in tumor size due to hyperplasia of residual adipocytes, when tumor growth is associated with neurological deterioration.

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Posterolateral cervical or thoracic approach with spinal cord rotation for vascular malformations or tumors of the ventrolateral spinal cord

Journal of Neurosurgery ◽

10.3171/jns.1995.83.2.0254 ◽

1995 ◽

Vol 83 (2) ◽

pp. 254-261 ◽

Cited By ~ 69

Author(s):

Neil A. Martin ◽

Rohit K. Khanna ◽

Ulrich Batzdorf

Keyword(s):

Spinal Cord ◽

Anterior Spinal Artery ◽

Posterolateral Approach ◽

Spinal Instability ◽

Thoracic Spinal Cord ◽

Entry Zone ◽

Content Type ◽

Root Entry Zone ◽

Thoracic Spinal ◽

Fine Print

✓ This report describes a technique for exposing the ventrolateral quadrant of the spinal cord through an extended posterolateral approach that can be used in both cervical and thoracic regions. The surgical technique includes the following: 1) a midline skin incision with a transverse extension at the level of pathology; 2) unilateral division and retraction of the paraspinous muscles; 3) laminectomy and unilateral removal of facets and pedicles; 4) dural incision over the dorsal root entry zone; 5) multilevel division of the ipsilateral dentate ligaments; and 6) elevation and rotation of the spinal cord with dentate traction stitches. This technique provides exposure of the ventral root entry zone, the ipsilateral half of the ventral surface of the cord, and the anterior spinal artery. The surface of the spinal cord beyond the anterior spinal artery is not seen. This approach has been used for the treatment of seven ventrolateral spinal cord lesions: five spinal arteriovenous malformations (two Type II, one Type III, two Type IV), one hemangioblastoma, and one cavernous angioma. All the lesions were completely excised. Two patients had mild new neurological deficit after surgery, and one adolescent developed mild asymptomatic thoracic kyphosis, but no other spinal instability was observed over a follow-up period of 1 to 4 years. This operative approach provides significant advantages for ventrolateral perimedullary or intramedullary lesions of the cervical or thoracic spinal cord.

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