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

1999 ◽  
Vol 91 (1) ◽  
pp. 105-111 ◽  
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.

Angiographic study of the effect of laminectomy in the presence of acute anterior epidural masses

1976 ◽  
Vol 45 (2) ◽  
pp. 195-202 ◽  
Author(s):  
John L. Doppman ◽  
Mary Girton
Keyword(s):  
Spinal Cord ◽  
Posterior Approach ◽  
Anterior Spinal Artery ◽  
Angiographic Study ◽  
Content Type ◽  
Posterior Displacement ◽  
Neurologically Intact ◽  
Fine Print

✓ Laminectomies were performed in 16 monkeys to decompress simulated acute epidural masses in front of the spinal cord. When decompression restored normal arterial and venous hemodynamics, the monkeys were neurologically intact in spite of considerable mechanical distortion of the cord. When either the anterior spinal artery or the posterior spinal vein remained obstructed following laminectomy, the monkeys were paraplegic. Acute anterior epidural masses larger than 4 mm in diameter could not be adequately decompressed via the posterior approach. Only minor posterior displacement of the cord is observed following laminectomy in the presence of large anterior masses.

Microangioarchitecture of the feline spinal cord

1987 ◽  
Vol 66 (3) ◽  
pp. 447-452 ◽  
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.

Spinal Cord Herniation

2005 ◽  
Vol 3 (6) ◽  
pp. 508-509
Author(s):  
Laurence Marshman
Keyword(s):  
Spinal Cord ◽  
Dura Mater ◽  
Posterior Approach ◽  
Direct Manipulation ◽  
Dural Repair ◽  
Content Type ◽  
Novel Approach ◽  
Spinal Cord Herniation ◽  
Thoracic Cord ◽  
Fine Print

Anterior spinal cord herniation is a well-documented condition in which the thoracic cord becomes tethered within a defect in the anterior dura mater. Typical procedures have involved a posterior approach with direct manipulation of the thoracic cord to expose and blindly release its point of tethering. The authors report three cases in which a novel approach for the treatment of anterior thoracic cord herniation was performed, cord manipulation and traction are minimized, and direct dural repair of the defect is performed.

Paraplegia following thoracolumbar sympathectomy

1971 ◽  
Vol 34 (4) ◽  
pp. 569-571 ◽  
Author(s):  
Ronald F. Shallat ◽  
Thomas E. Klump
Keyword(s):  
Spinal Cord ◽  
Anterior Spinal Artery ◽  
Intercostal Artery ◽  
Spinal Cord Infarction ◽  
Content Type ◽  
Fine Print

✓ A case is presented in which a bilateral thoracolumbar sympathectomy and splanchnicectomy were followed by permanent paraplegia below T-10. The hypothesis is presented that coagulation of a bleeding intercostal vessel during surgery led to a propagating thrombus which involved, successively, the intercostal artery, a segmental medullary vessel, and the anterior spinal artery with resulting spinal cord infarction. Other possible mechanisms are mentioned. Several technical suggestions are offered with regard to prevention of this complication.

Comparison of anterior and posterior surgical approaches in the treatment of ventral spinal hemangioblastomas in patients with von Hippel—Lindau disease

2003 ◽  
Vol 98 (1) ◽  
pp. 117-124 ◽  
Author(s):  
Ryszard M. Pluta ◽  
Brian Iuliano ◽  
Hetty L. Devroom ◽  
Tung Nguyen ◽  
Edward H. Oldfield
Keyword(s):  
Spinal Cord ◽  
Anterior Approach ◽  
Posterior Approach ◽  
Long Term Results ◽  
Surgical Approaches ◽  
Content Type ◽  
Von Hippel Lindau ◽  
Vhl Disease ◽  
Ventral Spinal Cord ◽  
Fine Print

Object. Von Hippel—Lindau (VHL) disease is an autosomal-dominant neoplastic syndrome with manifestations in multiple organs, which is evoked by the deletion or mutation of a tumor suppressor gene on chromosome 3p25. Spinal hemangioblastomas (40% of VHL disease—associated lesions of the central nervous system) arise predominantly in the posterior aspect of the spinal cord and are often associated with an intraspinal cyst. Rarely, the tumor develops in the anterior aspect of the spinal cord. Ventral spinal hemangioblastomas are a surgical challenge because of difficult access and because vessels feeding the tumor originate from the anterior spinal artery. The goal of this study was to clarify whether an anterior or posterior surgical approach is better for management of hemangioblastomas of the ventral spinal cord. Methods. The authors performed a retrospective analysis of clinical outcomes and findings on magnetic resonance (MR) imaging studies in eight patients (two women and six men with a mean age of 34 ± 15 years) who underwent resection of ventral spinal hemangioblastomas (nine tumors: five cervical and four thoracic). Two surgical approaches were used to resect these tumors. A posterior approach was selected to treat five patients (laminectomy and posterior myelotomy in four patients and the posterolateral approach in one patient); an anterior approach (corpectomy and arthrodesis) was selected to treat the remaining three patients. Immediately after surgery, the ability to ambulate remained unchanged in patients in whom an anterior approach had been performed, but deteriorated significantly in patients in whom a posterior approach had been used, because of motor weakness (four of five patients) and/or proprioceptive sensory loss (three of five patients). This difference in ambulation, despite significant improvements over time among patients in the posterior access group, remained significant 6 months after surgery. In all cases, MR images revealed complete resection of the tumor and in five patients significant or complete resolution of the intramedullary cyst was demonstrated (present in six of eight patients). Conclusions. The outcomes of these eight patients with hemangioblastomas of the ventral spinal cord indicate that both immediate and long-term results are better when an anterior approach is selected for resection.

Experimental use of cultured cerebellar cortical tissue to inhibit the collagenous scar following spinal cord transection

1970 ◽  
Vol 33 (2) ◽  
pp. 127-139 ◽  
Author(s):  
Chun Ching Kao ◽  
Yoshifusa Shimizu ◽  
Lois C. Perkins ◽  
L. W. Freeman
Keyword(s):  
Spinal Cord ◽  
Axonal Regeneration ◽  
Spinal Cord Transection ◽  
The Other ◽  
Cortical Tissue ◽  
Content Type ◽  
Experimental Use ◽  
Cortical Slices ◽  
Control Study ◽  
Fine Print

✓ Two types of barrier to axonal regeneration in the spinal cord were found in experimental spinal cord transection in dogs. One was an astroglial scar formed within the spinal cord, and the other a collagenous scar in the gap between proximal and distal stumps. Autogeneous cultured cerebellar cortical slices transplanted into the space produced by cord transection in adult dogs inhibited collagenous scar formation and converted the gap into a spongy structure. The astroglial scar within the spinal cord remained unchanged. Conversely, transplantation of noncultured cortical slices as a control study enhanced formation of the collagenous scar.

Unruptured aneurysm of the anterior spinal artery presenting as paraparesis

1976 ◽  
Vol 45 (3) ◽  
pp. 331-333 ◽  
Author(s):  
Peter J. Leech ◽  
Bryant A. R. Stokes ◽  
Trevor Apsimon ◽  
Clive Harper
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Compression ◽  
Cord Compression ◽  
Unruptured Aneurysm ◽  
Neurological Recovery ◽  
Anterior Spinal Artery ◽  
Content Type ◽  
Fine Print

✓ A case is presented in which spinal cord compression was caused by an unruptured aneurysm of the anterior spinal artery. The nature of the mass was not disclosed until it was surgically exposed. Resection of the sac was followed by neurological recovery.

Transarterial embolization of aneurysms associated with spinal cord arteriovenous malformations

1999 ◽  
Vol 90 (1) ◽  
pp. 148-154 ◽  
Author(s):  
Alexis Victorien Konan ◽  
Jean Raymond ◽  
Daniel Roy
Keyword(s):  
Spinal Cord ◽  
Arteriovenous Malformations ◽  
Transarterial Embolization ◽  
Apparent Volume ◽  
Anterior Spinal Artery ◽  
Mr Images ◽  
Content Type ◽  
Hemorrhagic Events ◽  
Fine Print

✓ The authors sought to show the feasibility and discuss the rationale of embolization of aneurysms associated with spinal cord arteriovenous malformations (SCAVMs). The authors reviewed the clinical presentation, magnetic resonance (MR) images, spinal angiograms, and clinical evolution of four patients treated for aneurysms associated with an SCAVM. Aneurysms were located on branches of the anterior spinal artery in three patients and on radiculopial arteries in two patients; one patient harbored two lesions. Treatment consisted of superselective bucrylate embolization of the branches harboring the aneurysms, with preservation of the arterial axis. Follow-up angiograms were obtained at 3 to 6 months postembolization in all patients. All patients presented with hemorrhagic events. Hematomyelia was clearly related to a sulcocommissural or a vasa corona aneurysm in two patients. Another sulcocommissural aneurysm and multiple radiculopial aneurysms were presumed to be the cause of subarachnoid hemorrhage in two other patients. One patient harbored aneurysms on a sulcocommissural artery and on a radiculopial artery. All aneurysms were permanently obliterated. In one patient with a single fistula, the SCAVM was cured. The SCAVM was only partially obliterated (95, 50, and 20% in apparent volume) in three other patients. There were no complications or rebleeding episodes during a follow-up period of 17 to 37 months. Aneurysms associated with SCAVMs can be eradicated by supraselective embolization, even on the anterior spinal artery territory. For patients presenting with hemorrhage and prohibitive risk of complete resection, embolization of aneurysms may decrease the risk of further rebleeding.

Absence of vasospastic response of the anterior spinal artery to subarachnoid blood

1977 ◽  
Vol 47 (1) ◽  
pp. 64-67 ◽  
Author(s):  
John L. Doppman ◽  
Mary Girton
Keyword(s):  
Spinal Cord ◽  
Direct Measurement ◽  
Subarachnoid Space ◽  
Autologous Blood ◽  
Anterior Spinal Artery ◽  
Content Type ◽  
Intracranial Arteries ◽  
Subarachnoid Blood ◽  
Fine Print ◽  
Lumbar Subarachnoid Space

✓ Autologous blood (0.3 to 5.0 ml) was introduced into the lumbar subarachnoid space of nine monkeys. Serial spinal cord arteriography was performed at frequent intervals over a 24-hour period. Magnification techniques permitted direct measurement of the anterior spinal artery and posterior spinal vein. Neither immediate nor delayed spasm was observed in any animal. Similar techniques have routinely produced spasm of intracranial arteries in our laboratory.

Electrical spinal cord stimulation in reflex sympathetic dystrophy: retrospective analysis of 23 patients

1999 ◽  
Vol 90 (1) ◽  
pp. 79-83 ◽  
Author(s):  
Marius A. Kemler ◽  
Gerard A. M. Barendse ◽  
Maarten Van Kleef ◽  
Frans A. J. M. Van Den Wildenberg ◽  
Wilhelm E. J. Weber
Keyword(s):  
Spinal Cord ◽  
Pain Score ◽  
Spinal Cord Stimulation ◽  
Reflex Sympathetic Dystrophy ◽  
Clinical Status ◽  
Test Period ◽  
The Other ◽  
Content Type ◽  
Fine Print

Object. The aim of the study was to assess retrospectively the clinical efficacy and possible adverse effects of electrical spinal cord stimulation (SCS) for the treatment of patients with reflex sympathetic dystrophy (RSD). Methods. Twenty-three patients who suffered severe pain due to RSD were included in the study. The SCS system was implanted only after a positive 1-week test period. The visual analog scale (VAS) score for pain (1–10) was obtained in all patients prior to treatment, 1 month postimplantation, and at last follow up. At final follow-up examination, patients were asked to rate the effect of their treatment on the 7-point global perceived effect scale. Eighteen (78%) of 23 patients treated between 1991 and 1997 reported improvement during the test period. Permanent implantation of SCS system was not performed in the other five patients. Complications occurred in nine (50%) of 18 patients. The system was removed in three patients after implantation (17%). At the end of follow up (mean 32 months) 15 patients still had an implanted system. The mean pain score had decreased from 7.9 to 5.4 (p < 0.001). In the other eight patients the pain score had not changed significantly. In 13 patients (57%) in whom the SCS system was implanted, clinical status had much improved or improved; these cases were regarded as successful. Conclusions. In this retrospective series, the majority of patients with RSD reported a subjective improvement after implantation of an SCS system.

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