Rotational angiography for diagnosis and surgical planning in the management of spinal vascular lesions

2012 ◽  
Vol 32 (5) ◽  
pp. E6 ◽  
Author(s):  
Alexander E. Ropper ◽  
Ning Lin ◽  
Bradley A. Gross ◽  
Hekmat K. Zarzour ◽  
Ruth Thiex ◽  
...  
Keyword(s):  
Vascular Malformations ◽  
Three Dimensional ◽  
Vascular Pathology ◽  
Vascular Lesions ◽  
Spinal Angiography ◽  
Rotational Angiography ◽  
Spinal Vascular Malformations ◽  
Significant Difference ◽  
Surgical Treatment Planning

Object The management of spinal vascular malformations has undergone significant evolution with the advent of advanced endovascular and angiographic technology. Three-dimensional rotational spinal angiography is an advanced tool that allows the surgeon to gain a better appreciation of the anatomy of these spinal vascular lesions and their relation to surrounding structures. This article describes the use of rotational angiography and 3D reconstructions in the diagnosis and management of spinal vascular malformations. Methods The authors present representative cases involving surgical treatment planning for spinal vascular malformations with focus on the utility and technique of rotational spinal angiography. They report the use of rotational spinal angiography for a heterogeneous collection of vascular pathological conditions. Results Eight patients underwent rotational spinal angiography in addition to digital subtraction angiography (DSA) for the diagnosis and characterization of various spinal vascular lesions. Postprocessed images were used to characterize the lesion in relation to surrounding bone and to enhance the surgeon's ability to precisely localize and obliterate the abnormality. The reconstructions provided superior anatomical detail compared with traditional DSA. No associated complications from the rotational angiography were noted, and there was no statistically significant difference in the amount of radiation exposure to patients undergoing rotational angiography relative to traditional angiography. Conclusions The use of rotational spinal angiography provides a rapid and powerful diagnostic tool, superior to conventional DSA in the diagnosis and preoperative planning of a variety of spinal vascular pathology. A more detailed understanding of the anatomy of such lesions provided by this technique may improve the safety of the surgical approach.

scholarly journals Introduction: Spinal Vascular Malformations

2009 ◽  
Vol 26 (1) ◽  
pp. E1 ◽  
Author(s):  
Edward H. Oldfield
Keyword(s):  
Spinal Cord ◽  
Vascular Malformations ◽  
Vascular Lesions ◽  
Successful Management ◽  
Anatomical Features ◽  
Spinal Vascular Malformations ◽  
Cord Injury ◽  
Selective Arteriography ◽  
The 1960S ◽  
Made In

From the earliest observations of spinal vascular malformations, successful management has been challenging. Initially the challenges were diagnosing, understanding, and treating these lesions. They were originally considered all to be the same, or at least to be a single general type, of disease. With the introduction of selective spinal arteriography in the 1960s and more recently with the introduction and widespread use of MR imaging, the initial challenge of diagnosing spinal vascular malformations was overcome, and significant progress has been made in understanding their anatomy as well as the pathophysiology that underlies the myelopathy commonly associated with them. The anatomical features defined by selective arteriography and the observations permitted with the operating microscope ultimately led to distinctions between the major categories of the vascular lesions affecting the spinal cord; these distinctions were based on the lesions' anatomy, epidemiology, and the mechanism of spinal cord injury.

Volumetric T2-weighted MRI improves the diagnostic accuracy of spinal vascular malformations: comparative analysis with a conventional MR study

2019 ◽  
Vol 11 (10) ◽  
pp. 1019-1023 ◽  
Author(s):  
Santhosh Kumar Kannath ◽  
Adhithyan Rajendran ◽  
Bejoy Thomas ◽  
Jayadevan Enakshy Rajan
Keyword(s):  
Diagnostic Accuracy ◽  
Likelihood Ratio ◽  
Vascular Malformations ◽  
Positive Likelihood Ratio ◽  
Negative Likelihood Ratio ◽  
Vascular Lesions ◽  
Volumetric Mri ◽  
Spinal Vascular Malformations ◽  
Sensitivity Specificity ◽  
T2 Mri

BackgroundTo date, very little study of the importance of a volumetric T2-weighted MR sequence in the evaluation of spinal vascular malformations (SVMs) has been carried out.ObjectiveTo determine the utility and accuracy of a volumetric T2 MR sequence compared with conventional T2 in the diagnosis of SVMs.MethodsRetrospective analysis of all patients who underwent spinal DSA for suspected SVMs was conducted. Conventional T2 and volumetric T2 MR images were analysed for the presence of flow voids and parenchymal changes, and SVMs were characterized. The sensitivity, specificity, and overall diagnostic accuracy of these MRI diagnoses were calculated.ResultsOf 89 subjects included in the final analysis, 70 patients had angiographically proved SVMs (38 patients with spinal cord arteriovenous malformations [SCAVM—intramedullary or perimedullary] and 32 cases of spinal dural arteriovenous fistula (SDAVF)) and the remaining 19 subjects were normal. The sensitivity and specificity for identification of SVMs were 98.1% and 90% for volumetric T2 sequences, compared with 82.8% and 89.4% for conventional T2 MRI, respectively. For characterization of spinal vascular lesions, volumetric MRI showed high sensitivity, specificity, and accuracy for SDAVF (100%, 90%, 97%, respectively) compared with conventional T2 MRI (71.8%, 89%, 79%, respectively). The positive likelihood ratio was high and negative likelihood ratio was zero for volumetric MRI evaluation of SDAVF, while these ratios were comparable between the two sequences for SCAVM.ConclusionVolumetric T2 MRI is highly sensitive for the detection of SVMs, especially for SDAVF. Volumetric T2 MRI could be introduced into routine clinical practice in the screening of suspected SVMs.

A bioartificial rat heart tissue: Perfusion decellularization and characterization

2019 ◽  
Vol 42 (12) ◽  
pp. 757-764 ◽  
Author(s):  
Busra Ozlu ◽  
Mert Ergin ◽  
Sevcan Budak ◽  
Selcuk Tunali ◽  
Nuh Yildirim ◽  
...  
Keyword(s):  
Extracellular Matrix ◽  
Three Dimensional ◽  
Tissue Perfusion ◽  
Heart Tissue ◽  
Cell Nuclei ◽  
Tissue Sections ◽  
The Past ◽  
Significant Difference ◽  
Structural Preservation

Despite remarkable advancement in the past decades, heart-related defects are still prone to progress irreversibly and can eventually lead to heart failure. A personalized extracellular matrix–based bioartificial heart created by allografts/xenografts emerges as an alternative as it can retain the original three-dimensional architecture combined with a preserved natural heart extracellular matrix. This study aimed at developing a procedure for decellularizing heart tissue harvested from rats and evaluating decellularization efficiency in terms of residual nuclear content and structural properties. Tissue sections showed no or little visible cell nuclei in decellularized heart, whereas the native heart showed dense cellularity. In addition, there was no significant variation in the alignment of muscle fibers upon decellularization. Furthermore, no significant difference was detected between native and decellularized hearts in terms of fiber diameter. Our findings demonstrate that fiber alignment and diameter can serve as additional parameters in the characterization of biological heart scaffolds as these provide valuable input for evaluating structural preservation of decellularized heart. The bioartificial scaffold formed here can be functionalized with patient’s own material and utilized in regenerative engineering.

Aneurysm presence at the anterior communicating artery bifurcation is associated with caliber tapering of the A1 segment

2021 ◽  
pp. 1-11
Author(s):  
Alexandra Lauric ◽  
Luke Silveira ◽  
Emal Lesha ◽  
Jeffrey M. Breton ◽  
Adel M. Malek
Keyword(s):  
Three Dimensional ◽  
Parametric Models ◽  
Anterior Communicating Artery ◽  
Predisposing Factor ◽  
Cross Sectional ◽  
Flow Acceleration ◽  
Significant Difference ◽  
Healthy Control ◽  
Mca Aneurysm

OBJECTIVE Vessel tapering results in blood flow acceleration at downstream bifurcations (firehose nozzle effect), induces hemodynamics predisposing to aneurysm initiation, and has been associated with middle cerebral artery (MCA) aneurysm presence and rupture status. The authors sought to determine if vessel caliber tapering is a generalizable predisposing factor by evaluating upstream A1 segment profiles in association with aneurysm presence in the anterior communicating artery (ACoA) complex, the most prevalent cerebral aneurysm location associated with a high rupture risk. METHODS Three-dimensional rotational angiographic studies were analyzed for 68 patients with ACoA aneurysms, 37 nonaneurysmal contralaterals, and 53 healthy bilateral controls (211 samples total). A1 segments were determined to be dominant, codominant, or nondominant based on flow and size. Equidistant cross-sectional orthogonal cuts were generated along the A1 centerline, and cross-sectional area (CSA) was evaluated proximally and distally, using intensity-invariant edge detection filtering. The relative tapering of the A1 segment was evaluated as the tapering ratio (distal/proximal CSA). Computational fluid dynamics was simulated on ACoA parametric models with and without tapering. RESULTS Aneurysms occurred predominantly on dominant (79%) and codominant (17%) A1 segments. A1 segments leading to unruptured ACoA aneurysms had significantly greater tapering compared to nonaneurysmal contralaterals (0.69 ± 0.13 vs 0.80 ± 0.17, p = 0.001) and healthy controls (0.69 ± 0.13 vs 0.83 ± 0.16, p < 0.001), regardless of dominance labeling. There was no statistically significant difference in tapering values between contralateral A1 and healthy A1 controls (0.80 ± 0.17 vs 0.83 ± 0.16, p = 0.56). Hemodynamically, A1 segment tapering induces high focal pressure, high wall shear stress, and high velocity at the ACoA bifurcation. CONCLUSIONS Aneurysmal, but not contralateral or healthy control, A1 segments demonstrated significant progressive vascular tapering, which is associated with aneurysmogenic hemodynamic conditions at the ACoA complex. Demonstration of the upstream tapering effect in the communicating ACoA segment is consistent with its prior detection in the noncommunicating MCA bifurcation, which together form more than 50% of intracranial aneurysms. The mechanistic characterization of this upstream vascular tapering phenomenon is warranted to understand its clinical relevance and devise potential therapeutic strategies.

scholarly journals Spinal vascular malformations: an historical perspective

2006 ◽  
Vol 21 (6) ◽  
pp. 1-7 ◽  
Author(s):  
Perry Black
Keyword(s):  
Middle Ages ◽  
Historical Perspective ◽  
Vascular Malformations ◽  
Vascular Lesions ◽  
Spinal Vascular Malformations ◽  
Time Period ◽  
The 1960S ◽  
Biological Entities ◽  
Modern Era

✓In this historical perspective, the author identifies three epochs in the development of the concepts and treatment of spinal vascular lesions: 1) early observations (1860s–1912), with the lesions during this time period recognized only at autopsy; 2) the “middle ages” (1912–1960), with surgical intervention sporadic and yielding dismal results; and 3) the modern era (beginning in the 1960s), coincident with parallel dramatic advances in radiology, microsurgical instrumentation, and anesthesiology. These advances resulted in a better understanding of the pathophysiological aspects and angioarchitecture of the lesions. Whereas the nomenclature of the lesions in the past was confusing, a new understanding of these diseases that has emerged during the modern era has permitted refinement of the classification of the lesions as distinct biological entities. Modern diagnostic imaging has enabled identification of patients who may benefit from surgical or embolic occlusion, and treatment has become rationally based. Future progress in the management of spinal vascular lesions may be anticipated, with improvement in noninvasive imaging for early detection of suspected abnormalities. Furthermore, advances in spinal cord neuroprotection may expand the range of future options for surgical or embolic intervention.

scholarly journals 3D DCE-MRA in spinal vascular malformations

2021 ◽  
Author(s):  
Jibin Cao ◽  
Sijia Gao ◽  
Wenge Sun ◽  
Lingling Cui
Keyword(s):  
Spinal Cord ◽  
Surgical Treatment ◽  
Clinical Symptoms ◽  
Vascular Malformations ◽  
High Sensitivity ◽  
Vascular Lesions ◽  
Arterial Blood Supply ◽  
3 Dimensional ◽  
Spinal Vascular Malformations ◽  
Arterial Blood

Abstract Purpose: This study was carried out to investigate whether 3.0T dynamic enhanced 3 dimensional magnetic resonance angiography (3D DCE-MRA) could identify spinal cord vascular malformations efficiently.Material and Methods: 32 suspected cases of spinal vascular disease with MR imaging and clinical symptoms were detected using DCE-MRA. 28 patients were valued through DSA for 3-5 days, and surgical treatment was performed on 24 patients. Results: DCE-MRA was used to examine all the cases which recognized abnormal vascular lesions clearly, and 28 cases were consistent with DSA or surgical diagnosis. The arterial blood supply was evaluated accurately in 28 cases. The findings were correct in 26 cases.Conclusion: 3.0T DCE-MRA features high sensitivity and accuracy in detecting and characterizing SVMs, especially SDAVF.

scholarly journals Intramedullary Cavernoma: Case Report and Literature Review

2019 ◽  
Vol 2 (1) ◽  
Keyword(s):  
Spinal Cord ◽  
Vascular Malformations ◽  
Cord Compression ◽  
Lower Limbs ◽  
Low Flow ◽  
Vascular Lesions ◽  
Spinal Vascular Malformations ◽  
Patient Reported ◽  
Spinal Cord Compression Syndrome ◽  
Chronic Myelopathy

Introduction: Cavernomas are benign vascular anomalies consisting of cavities where the blood circulates at low flow and at low pressure. Intramedullary localization is unusual, represents approximately 5 to 12% of spinal vascular malformations and 3% of intra-dural vascular malformations (5% of medullary vascular lesions). Observation: A patient, aged 59, consulted for the abrupt installation of moderate back pain followed by predominant muscle weakness in the two lower limb of progressive worsening, responsible for gait disorders. The patient reported thermal hypoesthesia and heaviness of the two lower limbs that had been evolving for two years. The examination found a dorsal spinal cord compression syndrome. On the MRI, there were abnormalities of intramedullary signal of the dorsal (D11) spinal cord with bleeding stigmas suggestive of intramedullary cavernomas. Conclusion: The management of the medullary cavernoma is essentially neurosurgical with complete microsurgical resection of the malformation. In the absence of surgical treatment, evolution can be to chronic myelopathy or neurological aggravation.

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