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Pisa M, Watson JL, Spencer JI, Niblett G, Mahjoub Y, Lockhart A, Yates RL, Yee SA, Hadley G, Ruiz J, Esiri MM, Kessler B, Fischer R, DeLuca GC. A role for vessel-associated extracellular matrix proteins in multiple sclerosis pathology. Brain Pathol 2024; 34:e13263. [PMID: 38659387 PMCID: PMC11483522 DOI: 10.1111/bpa.13263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 04/05/2024] [Indexed: 04/26/2024] Open
Abstract
Multiple sclerosis (MS) is unsurpassed for its clinical and pathological hetherogeneity, but the biological determinants of this variability are unknown. HLA-DRB1*15, the main genetic risk factor for MS, influences the severity and distribution of MS pathology. This study set out to unravel the molecular determinants of the heterogeneity of MS pathology in relation to HLA-DRB1*15 status. Shotgun proteomics from a discovery cohort of MS spinal cord samples segregated by HLA-DRB*15 status revealed overexpression of the extracellular matrix (ECM) proteins, biglycan, decorin, and prolargin in HLA-DRB*15-positive cases, adding to established literature on a role of ECM proteins in MS pathology that has heretofore lacked systematic pathological validation. These findings informed a neuropathological characterisation of these proteins in a large autopsy cohort of 41 MS cases (18 HLA-DRB1*15-positive and 23 HLA-DRB1*15-negative), and seven non-neurological controls on motor cortical, cervical and lumbar spinal cord tissue. Biglycan and decorin demonstrate a striking perivascular expression pattern in controls that is reduced in MS (-36.5%, p = 0.036 and - 24.7%, p = 0.039; respectively) in lesional and non-lesional areas. A concomitant increase in diffuse parenchymal accumulation of biglycan and decorin is seen in MS (p = 0.015 and p = 0.001, respectively), particularly in HLA-DRB1*15-positive cases (p = 0.007 and p = 0.046, respectively). Prolargin shows a faint parenchymal pattern in controls that is markedly increased in MS cases where a perivascular deposition pattern is observed (motor cortex +97.5%, p = 0.001; cervical cord +49.1%, p = 0.016). Our findings point to ECM proteins and the vascular interface playing a central role in MS pathology within and outside the plaque area. As ECM proteins are known potent pro-inflammatory molecules, their parenchymal accumulation may contribute to disease severity. This study brings to light novel factors that may contribute to the heterogeneity of the topographical variation of MS pathology.
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Affiliation(s)
- Marco Pisa
- Nuffield Department of Clinical NeurosciencesUniversity of OxfordOxfordUK
| | | | - Jonathan I. Spencer
- Centre for Cardiovascular Medicine and DevicesWilliam Harvey Research Institute, Queen Mary University of LondonLondonUK
| | - Guy Niblett
- Oxford Medical SchoolUniversity of OxfordOxfordUK
| | - Yasamin Mahjoub
- Faculty of MedicineUniversity of AlbertaEdmontonAlbertaCanada
| | - Andrew Lockhart
- Nuffield Department of Clinical NeurosciencesUniversity of OxfordOxfordUK
| | - Richard L. Yates
- Nuffield Department of Clinical NeurosciencesUniversity of OxfordOxfordUK
| | - Sydney A. Yee
- Nuffield Department of Clinical NeurosciencesUniversity of OxfordOxfordUK
| | - Gina Hadley
- Nuffield Department of Clinical NeurosciencesUniversity of OxfordOxfordUK
| | - Jennifer Ruiz
- Mandell MS CenterTrinity Health of New EnglandHartfordConnecticutUSA
| | - Margaret M. Esiri
- Nuffield Department of Clinical NeurosciencesUniversity of OxfordOxfordUK
| | - Benedict Kessler
- Mass Spectrometry LaboratoryTarget Discovery Institute, University of OxfordOxfordUK
| | - Roman Fischer
- Mass Spectrometry LaboratoryTarget Discovery Institute, University of OxfordOxfordUK
| | - Gabriele C. DeLuca
- Nuffield Department of Clinical NeurosciencesUniversity of OxfordOxfordUK
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Dikshit P, Sharma A, Mehrotra A, Verma PK, Das KK, Jaiswal AK. "Extra-cranial proximal pica aneurysm - a rare and surreptious cause of posterior fossa sah: case report and review of literature". Br J Neurosurg 2024; 38:958-962. [PMID: 34524040 DOI: 10.1080/02688697.2021.1970112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 08/14/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Extra-cranial posterior inferior cerebellar artery (PICA) aneurysms are rare with only 22 cases been reported so far. Intra-dural type of extra-cranial PICA aneurysm is even rarer with few case reports available. We report a previously unreported type of proximal PICA aneurysm in which the PICA aneurysm had intra-dural location at the C2 vertebral level. CASE DESCRIPTION A 51 year old gentleman presented with sub-arachnoid haemorrhage and intra-ventricular haemorrhage, predominantly involving the fourth ventricle and had no focal neurological deficit. CT angiogram was negative however a dedicated four vessel angiogram demonstrated an abnormal extracranial origin of right PICA at C1-C2 level, with associated aneurysm in its proximal segment. A C1 posterior arch excision with partial C2 laminectomy and clipping of the aneurysm was done. CONCLUSION Aneurysm associated with extracranial intra-dural PICA origin is a rare cause of SAH, and may not be detected with CT angiography. Such cases often require dedicated four vessel angiography, with careful study for any possibility of extra-cranial aneurysm. This variant has important surgical implication and requires preservation of the Lateral spinal artery (LSA-PICA communication), and that such aneurysm approached only with posterior cervical exposure without the need of a craniotomy. Such cases remind us the need to have an in-depth understanding of the variations of the posterior circulation.
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Affiliation(s)
- Priyadarshi Dikshit
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow, India
| | - Ashish Sharma
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow, India
| | - Anant Mehrotra
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow, India
| | - Pavan K Verma
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow, India
| | - Kuntal Kanti Das
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow, India
| | - Awadhesh Kumar Jaiswal
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow, India
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Liu W, Li J, Shu T, Ji Q, Wang X, Li R, Sui Y, He D, Xu Z. Preliminarily exploring the intraoperative ultrasonography characteristics of patients with degenerative cervical myelopathy. BMC Musculoskelet Disord 2024; 25:538. [PMID: 38997705 PMCID: PMC11241984 DOI: 10.1186/s12891-024-07601-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Accepted: 06/14/2024] [Indexed: 07/14/2024] Open
Abstract
BACKGROUND How to quickly read and interpret intraoperative ultrasound (IOUS) images of patients with degenerative cervical myelopathy (DCM) to obtain meaningful information? Few studies have systematically explored this topic. PURPOSE To systematically and comprehensively explore the IOUS characteristics of patients with DCM. MATERIALS AND METHODS This single-center study retrospectively included patients with DCM who underwent French-door laminoplasty (FDL) with IOUS guidance from October 2019 to March 2022. One-way ANOVA and Pearson's /Spearman's correlation analysis were used to analyze the correlations between the cross-sectional area of the spinal cord (SC) and individual characteristics; the relationships between the morphology, echogenicity, pulsation, decompression statuses, compression types of SC, location of the spinal cord central echo complex (SCCEC) and the disease severity (the preoperative Japanese Orthopedic Association score, preJOA score); the difference of the spinal cord pulsation amplitude(SCPA) and the SCCEC forward movement rate (FMR) between the compressed areas(CAs) and the non-compressed areas (NCAs). RESULTS A total of 38 patients were successfully enrolled (30 males and 8 females), and the mean age was 57.05 ± 10.29 (27-75) years. The cross-sectional area of the SC was negatively correlated with age (r = - 0.441, p = 0.006). The preJOA score was significantly lower in the heterogeneous group than in the homogeneous group (P < 0.05, p = 0.005). The hyperechoic area (HEA) was negatively while the SCCEC FMR was positively correlated with the preJOA score (r = - 0.334, p = 0.020; r = 0.286, p = 0.041). The SCCEC FMR and SCPA in CAs were significantly greater than those in NCAs (p < 0.05, p = 0.007; P < 0.001, P = 0.000). CONCLUSION The cross-sectional area of the SC decreases with age in adults. More changes in intramedullary echogenicity and less moving forward of the SCCEC often indicate poor SC status, and the SCCEC FMR and SCPA are more pronounced in CAs.
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Affiliation(s)
- Wenfen Liu
- Department of Ultrasound, The Seventh Affiliated Hospital of Sun Yat-Sen University, #628 Zhenyuan Road, Shenzhen, 518100, Guangdong, China
| | - Jiachun Li
- Department of Orthopaedics, The Seventh Affiliated Hospital of Sun Yat-Sen University, #628 Zhenyuan Road, Shenzhen, 518100, Guangdong, China
| | - Tao Shu
- Department of Orthopaedics, The Seventh Affiliated Hospital of Sun Yat-Sen University, #628 Zhenyuan Road, Shenzhen, 518100, Guangdong, China
| | - Qiao Ji
- Department of Ultrasound, The Seventh Affiliated Hospital of Sun Yat-Sen University, #628 Zhenyuan Road, Shenzhen, 518100, Guangdong, China
| | - Xianxiang Wang
- Department of Ultrasound, The Seventh Affiliated Hospital of Sun Yat-Sen University, #628 Zhenyuan Road, Shenzhen, 518100, Guangdong, China
| | - Renjie Li
- Department of Ultrasound, The Seventh Affiliated Hospital of Sun Yat-Sen University, #628 Zhenyuan Road, Shenzhen, 518100, Guangdong, China
| | - Yajuan Sui
- Department of Ultrasound, The Seventh Affiliated Hospital of Sun Yat-Sen University, #628 Zhenyuan Road, Shenzhen, 518100, Guangdong, China
| | - Danni He
- Department of Ultrasound, The Seventh Affiliated Hospital of Sun Yat-Sen University, #628 Zhenyuan Road, Shenzhen, 518100, Guangdong, China
| | - Zuofeng Xu
- Department of Ultrasound, The Seventh Affiliated Hospital of Sun Yat-Sen University, #628 Zhenyuan Road, Shenzhen, 518100, Guangdong, China.
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Nguyen G, Nguyen GK, Morón FE. Spinal cord watershed infarction after surgery. Radiol Case Rep 2024; 19:2706-2709. [PMID: 38666145 PMCID: PMC11043780 DOI: 10.1016/j.radcr.2024.03.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 02/29/2024] [Accepted: 03/12/2024] [Indexed: 04/28/2024] Open
Abstract
Spinal cord watershed infarction is a rare phenomenon due to the rich collateral blood supply to the organ. It often occurs in elderly patients with preexisting atherosclerotic disease in the setting of global hypoperfusion, such as thoracoabdominal surgery, dissection, coagulopathies, or idiopathic. We present a case of spinal cord infarction (SCI) in both longitudinal and transverse watershed areas as a complication of postoperative blood loss. In addition, we demonstrate the imaging evolution of spinal cord infarct in the subacute phase with peripheral enhancement due to the breakdown of the blood-spinal cord barrier.
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Affiliation(s)
- Gia Nguyen
- Touro College of Osteopathic Medicine, 60 Prospect Ave, Middletown, NY 10940, USA
| | - Giang-Kim Nguyen
- Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA
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Ke G, Liao H, Chen W. Clinical manifestations and magnetic resonance imaging features of spinal cord infarction. J Neuroradiol 2024; 51:101158. [PMID: 37816441 DOI: 10.1016/j.neurad.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 10/05/2023] [Accepted: 10/05/2023] [Indexed: 10/12/2023]
Abstract
BACKGROUND AND OBJECTIVE Spinal cord infarction (SCI) is a rare type of stroke, with no proposed classification or diagnostic criterium widely accepted and used in daily clinical practice currently. We try to explore the clinical manifestations and MRI features of SCI for improving the accurate diagnosis of SCI. METHODS Retrospectively analyzed the clinical data, MRI features, laboratory findings and outcomes of 40 patients who had been consecutively diagnosed with SCI in our hospital from June 2016 to January 2022. RESULTS Most of the SCI (92.5%) occurred at the level of T8-L2 and C4-T4. Transverse infarction (52.5%) and ASA territory infarction (27.5%) were the most common patterns. Longitudinally extensive lesions were noticed in 67.5% of the SCI and it might be a risk factor of poor prognosis (OR=21.11, 95%CI 2.14-208.29). Restricted diffusion of the SCI lesion occurred in 8h and a few lasted up to 60 days. All SCI showed spinal cord edema, accompanied by enhancement of the ventral cauda equina (13.8%), weakened enhancement of the dorsal venous plexus (44.8%), and vertebral infarction (25%). Most patients developed a stroke-like onset (92.5%) after movement (57.5%), with definite pain in the trunk or limbs (67.5%) and dissociative sensory disturbance (60.0%). The main etiologies of them include vascular abnormalities (45%) and iatrogenic injuries (15%). CONCLUSION An MRI classification of SCI based on the spinal cord blood supply was proposed. Restricted diffusion and co-existing abnormality of vertebral body and cauda equina may be the key neuroimaging feature for SCI diagnosis. Detailed history of vascular diseases or triggering factors are also helpful.
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Affiliation(s)
- Gaotan Ke
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Huiting Liao
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Weiwei Chen
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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Spiriev T, Laleva L, Milev M, Nakov V. How I do it: cervical hemangioblastoma resection. Surgical technique and complication avoidance. Acta Neurochir (Wien) 2024; 166:46. [PMID: 38285198 DOI: 10.1007/s00701-024-05949-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 11/25/2023] [Indexed: 01/30/2024]
Abstract
BACKGROUND Spinal cord hemangioblastomas are benign, highly vascular neoplasms that affect the brain and, rarely, the spinal cord. They can be solitary or as part of von Hippel-Lindau syndrome. Radiosurgery is not a suitable treatment option. Endovascular embolization can only be adjunct to surgery. METHOD We present a detailed approach to resection of a spinal cord hemangioblastoma. A video demonstrates the microsurgical technique and discusses complication avoidance. CONCLUSION The pitfalls to consider are preservation of normal spinal cord vessels, protection of the pia-arachnoid cleavage plane, and avoidance of tumor piecemeal removal. Careful microsurgical resection and detailed preoperative planning are key.
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Affiliation(s)
- Toma Spiriev
- Department of Neurosurgery, Acibadem City Clinic, University Hospital Tokuda, Sofia, Bulgaria.
| | - Lili Laleva
- Department of Neurosurgery, Acibadem City Clinic, University Hospital Tokuda, Sofia, Bulgaria
| | - Milko Milev
- Department of Neurosurgery, Acibadem City Clinic, University Hospital Tokuda, Sofia, Bulgaria
| | - Vladimir Nakov
- Department of Neurosurgery, Acibadem City Clinic, University Hospital Tokuda, Sofia, Bulgaria
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Ozono K, Son K, Momii K, Morifuji Y, Ikenaga N, Nakamura M. Severe hemothorax due to traumatic fracture of thoracic vertebra. Surg Case Rep 2024; 10:26. [PMID: 38265548 PMCID: PMC10808428 DOI: 10.1186/s40792-024-01819-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 01/09/2024] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Hemothorax occurs in approx. 0.4% of all chest injury patients, but hemothorax due to a thoracic vertebral fracture is rare. CASE PRESENTATION A 76-year-old Japanese man was transported to our hospital for right hemothorax due to a car accident. We performed emergency hemostasis surgery and tried to stop the bleeding by several methods, but it was difficult to control the bleeding because the bleeding point was an artery branch that runs in front of the vertebral body. CONCLUSION It is important to be aware that a fractured vertebra can damage the aorta's arterial branch and follow a severe course.
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Affiliation(s)
- Keigo Ozono
- Department of Surgery and Oncology, Graduate School of Medical Science, Kyushu University, Maidashi 3-1-1, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Kiwa Son
- Department of Surgery and Oncology, Graduate School of Medical Science, Kyushu University, Maidashi 3-1-1, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Kenta Momii
- Department of Emergency, Graduate School of Medical Science, Kyushu University, Fukuoka, Japan
| | | | - Naoki Ikenaga
- Department of Surgery and Oncology, Graduate School of Medical Science, Kyushu University, Maidashi 3-1-1, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Masafumi Nakamura
- Department of Surgery and Oncology, Graduate School of Medical Science, Kyushu University, Maidashi 3-1-1, Higashi-ku, Fukuoka, 812-8582, Japan
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Ribeiro A, Rebocho da Costa M, de Sena-Tomás C, Rodrigues EC, Quitéria R, Maçarico T, Rosa Santos SC, Saúde L. Development and repair of blood vessels in the zebrafish spinal cord. Open Biol 2023; 13:230103. [PMID: 37553073 PMCID: PMC10409570 DOI: 10.1098/rsob.230103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 07/18/2023] [Indexed: 08/10/2023] Open
Abstract
The vascular system is inefficiently repaired after spinal cord injury (SCI) in mammals, resulting in secondary tissue damage and immune deregulation that contribute to the limited functional recovery. Unlike mammals, zebrafish can repair the spinal cord (SC) and restore motility, but the vascular response to injury has not been investigated. Here, we describe the zebrafish SC blood vasculature, starting in development with the initial vessel ingression in a body size-dependent manner, the acquisition of perivascular support and the establishment of ventral to dorsal blood circulation. The vascular organization grows in complexity and displays multiple barrier specializations in adulthood. After injury, vessels rapidly regrow into the lesion, preceding the glial bridge and axons. Vascular repair involves an early burst of angiogenesis that creates dysmorphic and leaky vessels. Dysfunctional vessels are later removed, as pericytes are recruited and the blood-SC barrier is re-established. This study demonstrates that zebrafish can successfully re-vascularize the spinal tissue, reinforcing the value of this organism as a regenerative model for SCI.
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Affiliation(s)
- Ana Ribeiro
- Instituto de Medicina Molecular—João Lobo Antunes, Faculdade de Medicina da Universidade de Lisboa, Lisboa 1649-028 Portugal
| | - Mariana Rebocho da Costa
- Instituto de Medicina Molecular—João Lobo Antunes, Faculdade de Medicina da Universidade de Lisboa, Lisboa 1649-028 Portugal
| | - Carmen de Sena-Tomás
- Instituto de Medicina Molecular—João Lobo Antunes, Faculdade de Medicina da Universidade de Lisboa, Lisboa 1649-028 Portugal
| | - Elsa Charas Rodrigues
- Instituto de Medicina Molecular—João Lobo Antunes, Faculdade de Medicina da Universidade de Lisboa, Lisboa 1649-028 Portugal
| | - Raquel Quitéria
- Instituto de Medicina Molecular—João Lobo Antunes, Faculdade de Medicina da Universidade de Lisboa, Lisboa 1649-028 Portugal
| | - Tiago Maçarico
- Instituto de Medicina Molecular—João Lobo Antunes, Faculdade de Medicina da Universidade de Lisboa, Lisboa 1649-028 Portugal
| | - Susana Constantino Rosa Santos
- Centro Cardiovascular da Universidade de Lisboa (CCUL@RISE), Faculdade de Medicina da Universidade de Lisboa, Lisboa 1649-028 Portugal
| | - Leonor Saúde
- Instituto de Medicina Molecular—João Lobo Antunes, Faculdade de Medicina da Universidade de Lisboa, Lisboa 1649-028 Portugal
- Instituto de Histologia e Biologia do Desenvolvimento, Faculdade de Medicina da Universidade de Lisboa, Lisboa 1649-028 Portugal
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Nathani K, Ciriello J, Chaturvedi S. Rare Sighting: Enlarged Anterior Spinal Artery Providing Collateral Blood Flow to the Basilar Artery. J Clin Neurosci 2023; 114:89-92. [PMID: 37329665 DOI: 10.1016/j.jocn.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 06/05/2023] [Accepted: 06/09/2023] [Indexed: 06/19/2023]
Affiliation(s)
- Karan Nathani
- University of Maryland School of Medicine, Department of Neurology, 110 S. Paca St, Baltimore, MD 21201, United States.
| | - Jonathan Ciriello
- University of Maryland School of Medicine, Department of Neurology, 110 S. Paca St, Baltimore, MD 21201, United States
| | - Seemant Chaturvedi
- University of Maryland School of Medicine, Department of Neurology, 110 S. Paca St, Baltimore, MD 21201, United States
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Ota T. Functional Vascular Anatomy and Arteriovenous Shunts of the Spine. Semin Neurol 2023; 43:356-369. [PMID: 37536372 DOI: 10.1055/s-0043-1771209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
The history of vascular anatomy of the spinal cord and spine began in the late 19th century. With recent advances in endovascular and surgical treatment of vascular lesions of the spinal cord, understanding the vascular anatomy of the spinal cord has become more important than ever. Catheter angiography is the gold standard for diagnosing vascular lesions of the spinal cord, and the vascular architecture of the spinal cord itself is relatively simple, a repetition of basic longitudinal and axial structures. This review discusses the vascular anatomy of the spine and spinal cord from the embryological point of view, as well as an overview of typical spinal arteriovenous shunt diseases mainly depending on their locations: paraspinal, epidural, dural, perimedullary, intramedullary, filum terminale/cauda equina, craniocervical junction, and related diseases.
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Affiliation(s)
- Takahiro Ota
- Department of Neurosurgery, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
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Boukebous B, Serfaty L, Hodges-Tai TRR, Baker JF, Moyer JD, Rousseau MA. The Associative Pattern Between Segmental Arterial Damage and Complete Neurological Disorder After Spinal Cord Injury: A Case-Control Study. Cureus 2023; 15:e35918. [PMID: 36911583 PMCID: PMC9996064 DOI: 10.7759/cureus.35918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2023] [Indexed: 03/11/2023] Open
Abstract
INTRODUCTION The prevalence of vascular trauma surrounding the thoracic spine following Spinal Cord Injury (SCI) is unknown. The potential for neurologic recovery is uncertain in many cases; in some cases, neurologic assessment is not possible, for example, in severe head injury or early intubation, and detection of segmental artery injury may help as a predictive factor. OBJECTIVE To assess the prevalence of segmental vessel disruption in two groups, with and without neurologic deficit. MATERIAL AND METHODS This is a retrospective cohort study, with a group SCI American Spinal Injury Association (ASIA) E and a group SCI ASIA A. All patients had a high-energy thoracic or thoracolumbar fracture from T1 to L1. Patients were matched 1:1 (one ASIA A matched with one ASIA E) according to the fracture type, age, and level. The primary variable was the assessment of the presence/disruption of the segmental arteries, bilaterally, around the fracture. Analysis was performed twice by two independent surgeons in a blinded fashion. RESULTS Both groups had 2 type A, 8 type B, and 4 type C fractures. The right segmental artery was detected in 14/14 (100%) of the patients with ASIA E and in 3/14 (21%) or 2/14 (14%) of the patients with ASIA A, according to the observers, p=0.001. The left segmental artery was detectable in 13/14 (93%) or 14/14 (100%) of the patients ASIA E and in 3/14 (21%) of the patients ASIA A for both observers. All in all, 13/14 of the patients with ASIA A had at least one segmental artery undetectable. The sensibility varied between 78%to 92%, and the specificity from 82% to 100%. The Kappa Score varied between 0.55 and 0.78. CONCLUSION Segmental arteries disruption was common in the group ASIA A. This may help to predict the neurological status of patients with no complete neurological assessment or potential for recovery post-injury.
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Affiliation(s)
- Baptiste Boukebous
- Orthopaedics and Traumatology, Waikato District Health Board, Hamilton, NZL
| | - Lorenzo Serfaty
- Orthopedics and Traumatology, Bichat-Claude Bernard Hospital, Paris, FRA
| | - Te Ra R Hodges-Tai
- Orthopedics and Traumatology, Waikato District Health Board, Hamilton, NZL
| | - Joseph F Baker
- Orthopaedics and Traumatology, Waikato District Health Board, Hamilton, NZL
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Miyake T, Okada H, Kanda N, Mizuno Y, Suzuki K, Doi T, Yoshida T, Yoshida S, Ogura S. Spinal injury with spinal ankylosing disorders as a primary cause of death: report of two cases. Int J Emerg Med 2023; 16:7. [PMID: 36797663 PMCID: PMC9933250 DOI: 10.1186/s12245-023-00488-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 02/12/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Spinal ankylosing disorders (SADs) refer to a group of conditions resulting in spontaneous or postsurgical ossification and fusion of the spinal segments. The spine becomes increasingly susceptible to injury over time such that even low-energy trauma can cause a spinal injury. We report two cases of SADs, associated with massive thoracic hemorrhage. CASE PRESENTATION The first patient was an 85-year-old male, who suffered from a vehicular crash. He was diagnosed with a fracture of the first lumbar vertebra, accompanied by SADs. Intubation was required, and thoracic drainage tubes were inserted. The patient underwent a massive transfusion and thoracotomy with packing. Despite prompt treatment, the hemorrhage from the vertebral fracture was uncontrolled, and the patient died 180 min after the injury. The second case features an 88-year-old male who fell from a height. He was diagnosed with flail chest, hemothorax, pneumothorax, and a fracture of the eighth thoracic vertebra with SADs. After intubation, four thoracic drainage tubes were placed, and a massive transfusion was conducted. He died after 3 days due to hypoxemia secondary to persistent bleeding of the vertebral fracture for 24 h. CONCLUSIONS The patients died of persistent thoracic hemorrhage, and the sources of bleeding were the fracture site of the spine fractures. Controlling spinal hemorrhage is difficult due to the absence of a bleeding artery, which is managed via trans-arterial embolization. This report emphasized that fracture of SADs could be a fatal disease that requires prompt intervention.
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Affiliation(s)
- Takahito Miyake
- Advanced Critical Care Center, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194, Japan.
| | - Hideshi Okada
- grid.411704.7Advanced Critical Care Center, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194 Japan ,grid.256342.40000 0004 0370 4927Department of Emergency and Disaster Medicine, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194 Japan
| | - Norihide Kanda
- grid.411704.7Advanced Critical Care Center, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194 Japan
| | - Yosuke Mizuno
- grid.411704.7Advanced Critical Care Center, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194 Japan
| | - Kodai Suzuki
- grid.411704.7Advanced Critical Care Center, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194 Japan
| | - Tomoaki Doi
- grid.411704.7Advanced Critical Care Center, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194 Japan
| | - Takahiro Yoshida
- grid.411704.7Advanced Critical Care Center, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194 Japan
| | - Shozo Yoshida
- grid.411704.7Advanced Critical Care Center, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194 Japan ,grid.256342.40000 0004 0370 4927Department of Abuse Prevention Emergency Medicine, Gifu University Graduate School of Medicine, Gifu, 501-1194 Japan
| | - Shinji Ogura
- grid.411704.7Advanced Critical Care Center, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194 Japan ,grid.256342.40000 0004 0370 4927Department of Emergency and Disaster Medicine, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194 Japan
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13
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Anatomical study of arterial arrangement of the spinal cord in Syrian hamsters (Mesocricetus auratus). Anat Sci Int 2023; 98:107-122. [PMID: 35776237 DOI: 10.1007/s12565-022-00678-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 06/01/2022] [Indexed: 01/21/2023]
Abstract
This study aimed to investigate the arterial arrangement of the spinal cord in Syrian hamsters, and to identify differences and similarities to humans and experimental animals that are mostly used as models in studies into ischemic spinal cord injuries. This observational anatomical study was conducted on 20 adult Syrian hamsters using dissection and corrosion casting technique. The general anatomy of the arterial blood supply of spinal cord was obtained and noted as follows: (1) high variability in the level of the origin of right and left vertebral arteries, (2) the independent origin of dorsal intercostal arteries, (3) origin of lumbar arteries as a common trunk with right and left divisions, (4) presence of dorsal and ventral radicular branches in both sides of the cervical spinal cord with almost the same frequency, (5) greater presence of ventral and dorsal radicular branches in the left side of the thoracolumbar spinal cord, (6) two dorsal spinal arteries originating from the posterior inferior cerebellar arteries and extending to the caudal end of the thoracic spinal cord, (7) continuous ventral spinal artery originating from both vertebral arteries and extending to the conus medularis, and (8) presence of the artery of Adamkiewicz in the thoracic region of the spinal cord. From comparative anatomy viewpoints, the arteries supplying the spinal cord of Syrian hamsters exhibit many similarities with humans, laboratory rodents, and rabbits in many aspects compared to dogs, cats, and pigs. Overall, Syrian hamsters can be used as a proposed model in experimental studies of the spinal cord ischemia.
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14
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Parra JED, Ríos JB, García JFV. Variations in the origin of the anterior spinal artery in a Colombian population sample. Anat Cell Biol 2022; 55:520-524. [PMID: 36316283 PMCID: PMC9747338 DOI: 10.5115/acb.22.152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 09/19/2022] [Accepted: 10/04/2022] [Indexed: 12/13/2022] Open
Abstract
Based on most neuroanatomical descriptions, the anterior spinal artery (ASA) originates from two small vessels of the vertebral arteries, which are anastomosed just before forming the basilar artery. This study aimed to determine and quantify the possible variants of the origin of the ASA and its trajectory in samples of human brain stems. Male brain stems with the superior portion of the spinal cord until myelomera C3 of 23 adult human, and no evident morphological alterations were selected. The brain stems were collected for three years and fixed in a 10% formalin solution at the Anatomy Laboratory of the Universidad de Caldas (Colombia). Five samples (21.7%) had variations in the origin and trajectory of the anterior spinal artery. The variations in the origin of the ASA could generate morphofunctional advantages instead of leading to complications. That is the case when there are two anterior spinal arteries since it would increase tissue perfusion, thus protecting part of the spinal cord from ischemic pathologies. It is essential to consider the variations that may exist in the supply of the anterior region of the spinal cord for clinical and surgical assessments due to variations in its supplied territory.
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Affiliation(s)
- Jorge Eduardo Duque Parra
- Department of Basic Sciences, Program of Medicine, Universidad de Caldas, Manizales, Colombia,Department of Basic Sciences, Program of Medicine, Universidad de Manizales, Manizales, Colombia
| | - John Barco Ríos
- Department of Basic Sciences, Program of Medicine, Universidad de Caldas, Manizales, Colombia
| | - Juan Fernando Vélez García
- Department of Animal Health, Faculty of Veterinary Medicine and Zootechnics, Universidad del Tolima, Ibagué, Colombia,Corresponding author: Juan Fernando Vélez García, Department of Animal Health, Faculty of Veterinary Medicine and Zootechnics, Universidad del Tolima, Ibagué 730006299, Colombia, E-mail:
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15
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Ota T, Komiyama M. Vascular supply of the hindbrain: Basic longitudinal and axial angioarchitecture. Interv Neuroradiol 2022; 28:756-764. [PMID: 34935534 PMCID: PMC9706269 DOI: 10.1177/15910199211063011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 11/10/2021] [Indexed: 11/15/2022] Open
Abstract
The basic pattern of arterial vascularization is highly conserved across vertebrates and develops under neuromeric rules. The hindbrain has an angioarchitecture that is homologous to that of the spinal cord, and the hindbrain vascular system can be analyzed at the longitudinal and axial structures. During development, there are two main longitudinal arteries: the longitudinal neural artery and primitive lateral basilovertebral anastomosis. This review discusses the basic pattern of the blood supply of the hindbrain, the development of vascularization, and the anatomical variations, with a special reference to the embryological point of view of two main longitudinal anastomoses (longitudinal neural artery and primitive lateral basilovertebral anastomosis). The formation of commonly observed variations, such as fenestration and duplication of the vertebrobasilar artery, or primitive trigeminal artery variant, can be explained by the partial persistence of the primitive lateral basilovertebral anastomosis. Understanding the pattern and the development of the blood supply of the hindbrain provides useful information of the various anomalies of the vertebrobasilar junction and cerebellar arteries.
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Affiliation(s)
- Takahiro Ota
- Department of Neurosurgery, Tokyo Metropolitan Tama Medical Center, Tokyo,
Japan
| | - Masaki Komiyama
- Department of Neurointervention, Osaka City General Hospital, Osaka,
Japan
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16
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Albrakati A. Caveolar disruption with methyl-β-cyclodextrin causes endothelium-dependent contractions in Wistar rat carotid arteries. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:63071-63080. [PMID: 35445923 DOI: 10.1007/s11356-022-20226-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 04/09/2022] [Indexed: 06/14/2023]
Abstract
Caveolae are organizing centers for cellular signal transduction in endothelial cells (ED) and smooth muscle cells (SMCs) in the blood vessels. Myography was used to investigate the effects of a caveolar disruption using methyl-β-cyclodextrin (MBCD) on maxi-K channels in rat carotid arteries. Incubation of carotid segments with MBCD augmented contractions in response to BaK (chemical channel agonist) but not those induced by depolarizing high potassium physiological saline (KPSS). In contrast, incubation with cholesterol-saturated MBCD (Ch-MBCD) abolished the effects of MBCD. Mechanical removal of endothelial cells by MBCD triggered a small contraction in response to BaK. Incubation with nitroarginine methyl ester (L-NAME) inhibited nitric oxide (NO) release, causing increased contractions in response to BaK, and this effect was reversed by pretreatment with MBCD. These results suggest that MBCD inhibits endothelial NO release. Contrastingly, inhibition of maxi-K channels with iberiotoxin enhanced contractions in response to BaK. Likewise, L-NAME decreased the contractile effect of iberiotoxin, as in the ED-denuded arteries. Transmission electron microscopy (TEM) showed the presence and absence of caveolae in intact blood vessels before and after MBCD treatment, respectively, whereas histology confirmed ED removal after the treatment. Caveolar disruption using MBCD impairs ED-dependent relaxation by inhibiting the release of NO from the ED and altered the contractility of SMCs independent of the ED due to reduced contribution of maxi-K channels to the SMC membrane potential, causing depolarization and increasing carotid artery contraction. These findings might help to understand the physiological role of the maxi-K channels in rat carotid arteries.
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Affiliation(s)
- Ashraf Albrakati
- Department of Human Anatomy, College of Medicine, Taif University, P.O. Box 11099, Taif, 21944, Saudi Arabia.
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17
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Simultaneous Association of Variations in the Origin and Diameter of the Left Vertebral Artery in a Patient with a C1 Lateral Mass Tumor. Case Rep Surg 2022; 2022:1025019. [PMID: 35527807 PMCID: PMC9072035 DOI: 10.1155/2022/1025019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 04/11/2022] [Indexed: 01/10/2023] Open
Abstract
The anomalous origin of a hypoplastic Left Vertebral Artery (LVA) from the aortic arch is a rare anatomic variant. This study discusses the case of a patient with a C1 lateral mass tumor that surrounded a dominant Right Vertebral Artery (RVA) according to preoperative computed tomography angiography, with a hypoplastic LVA originating from the aortic arch. Surgery was performed, and the patient recovered uneventfully. To date, no study has reported the simultaneous association of two variations (origin and diameter) in the LVA. A deep understanding of abnormalities in the diameter and origin of LVA is a must for neurosurgeons as well as for thoracic and vascular surgeons to conduct surgical procedures.
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18
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Kiang L, Woodington B, Carnicer-Lombarte A, Malliaras G, Barone DG. Spinal cord bioelectronic interfaces: opportunities in neural recording and clinical challenges. J Neural Eng 2022; 19. [PMID: 35320780 DOI: 10.1088/1741-2552/ac605f] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 03/23/2022] [Indexed: 11/11/2022]
Abstract
Bioelectronic stimulation of the spinal cord has demonstrated significant progress in restoration of motor function in spinal cord injury (SCI). The proximal, uninjured spinal cord presents a viable target for the recording and generation of control signals to drive targeted stimulation. Signals have been directly recorded from the spinal cord in behaving animals and correlated with limb kinematics. Advances in flexible materials, electrode impedance and signal analysis will allow SCR to be used in next-generation neuroprosthetics. In this review, we summarize the technological advances enabling progress in SCR and describe systematically the clinical challenges facing spinal cord bioelectronic interfaces and potential solutions, from device manufacture, surgical implantation to chronic effects of foreign body reaction and stress-strain mismatches between electrodes and neural tissue. Finally, we establish our vision of bi-directional closed-loop spinal cord bioelectronic bypass interfaces that enable the communication of disrupted sensory signals and restoration of motor function in SCI.
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Affiliation(s)
- Lei Kiang
- Orthopaedic Surgery, Singapore General Hospital, Outram Road, Singapore, Singapore, 169608, SINGAPORE
| | - Ben Woodington
- Department of Engineering, University of Cambridge, Electrical Engineering Division, 9 JJ Thomson Ave, Cambridge, Cambridge, CB2 1TN, UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND
| | - Alejandro Carnicer-Lombarte
- Clinical Neurosciences, University of Cambridge, Bioelectronics Laboratory, Cambridge, CB2 0PY, UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND
| | - George Malliaras
- University of Cambridge, University of Cambridge, Cambridge, CB2 1TN, UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND
| | - Damiano G Barone
- Department of Engineering, University of Cambridge, Electrical Engineering Division, 9 JJ Thomson Ave, Cambridge, Cambridge, Cambridgeshire, CB2 1TN, UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND
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19
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Kim GW, Seo JH. Technical Report of Color Doppler Ultrasonography-Assisted Lumbar Spinal Interventions. Ultrasound Q 2022; 38:53-58. [PMID: 35239629 DOI: 10.1097/ruq.0000000000000575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Ultrasonography (US) has recently been used more frequently during interventions involving the lumbar spine. However, physicians who are more familiar with musculoskeletal US targeting muscles, tendons, and nerves may find it challenging to perform US-guided lumbar spine interventions using only bony landmarks. This study described the use of color Doppler US for the visualization of the lumbar spinal blood supply to identify vascular landmarks in addition to bony landmarks and thus more easily and accurately perform lumbar spine interventions.
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20
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Bouardi NEL, Chtaou N, Haloua M, Alami B, Youssef AL, Boubbou M, Belahsen F, Maaroufi M. Spinal cord infarction complicating acute aortic syndrome: about 2 cases. Radiol Case Rep 2022; 17:587-591. [PMID: 34976264 PMCID: PMC8688165 DOI: 10.1016/j.radcr.2021.11.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 11/17/2021] [Accepted: 11/21/2021] [Indexed: 11/28/2022] Open
Abstract
Spinal cord infarction is an uncommon but devastating disorder caused by various conditions. It remains however a rare neurological complication in acute aortic injuries. In this context, aortic dissection is the most frequent etiological factor. Acute aortic intra mural hematoma and atheromatous penetrating ulcer remain exceptional. We encountered two cases of spinal cord infarction associated with acute aortic intra mural hematoma in one case and atheromatous penetrating ulcer in the other case that presented without typical severe pain. Thus, acute aortic injuries should be considered a cause of spinal cord infarction even if there is little or no pain.
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Affiliation(s)
- Nizar EL Bouardi
- Radiology department, Hassan II university hospital, Fez, Morocco
- Faculty of medicine and pharmacy, Sidi Mohammed Ben Abdellah university, Fez, Morocco
- Corresponding author.
| | - Naïma Chtaou
- Neurology department, Hassan II university hospital, Fez, Morocco
- Faculty of medicine and pharmacy, Sidi Mohammed Ben Abdellah university, Fez, Morocco
| | - Meriam Haloua
- Radiology department, Hassan II university hospital, Fez, Morocco
- Faculty of medicine and pharmacy, Sidi Mohammed Ben Abdellah university, Fez, Morocco
| | - Badreddine Alami
- Radiology department, Hassan II university hospital, Fez, Morocco
- Faculty of medicine and pharmacy, Sidi Mohammed Ben Abdellah university, Fez, Morocco
| | - Alaoui Lamrani Youssef
- Radiology department, Hassan II university hospital, Fez, Morocco
- Faculty of medicine and pharmacy, Sidi Mohammed Ben Abdellah university, Fez, Morocco
| | - Meriem Boubbou
- Radiology department, Hassan II university hospital, Fez, Morocco
- Faculty of medicine and pharmacy, Sidi Mohammed Ben Abdellah university, Fez, Morocco
| | - Faouzi Belahsen
- Neurology department, Hassan II university hospital, Fez, Morocco
- Faculty of medicine and pharmacy, Sidi Mohammed Ben Abdellah university, Fez, Morocco
| | - Mustapha Maaroufi
- Radiology department, Hassan II university hospital, Fez, Morocco
- Faculty of medicine and pharmacy, Sidi Mohammed Ben Abdellah university, Fez, Morocco
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21
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Awad H, Raza A, Saklayen S, Bhandary S, Kelani H, Powers C, Bourekas E, Essandoh M. Combined Stroke and Spinal Cord Infarction in Hybrid Type I Aortic Arch Debranching and TEVAR and the Dual Role of the Left Subclavian Artery. J Cardiothorac Vasc Anesth 2022:S1053-0770(22)00122-7. [PMID: 35339354 DOI: 10.1053/j.jvca.2022.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 02/08/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Hamdy Awad
- Department of Anesthesiology at the Wexner Medical Center at the Ohio State University in Columbus, Columbus, OH.
| | - Arwa Raza
- Ohio State University College of Medicine in Columbus, Columbus, OH
| | - Samiya Saklayen
- Department of Anesthesiology at the Wexner Medical Center at the Ohio State University in Columbus, Columbus, OH
| | - Sujatha Bhandary
- Department of Anesthesiology at Emory University School of Medicine in Atlanta, Atlanta, GA
| | - Hesham Kelani
- Department of Anesthesiology at the Wexner Medical Center at the Ohio State University in Columbus, Columbus, OH
| | - Ciaran Powers
- Department of Neurosurgery at the Wexner Medical Center at the Ohio State University in Columbus, Columbus, OH
| | - Eric Bourekas
- Department of Radiology at Wexner Medical Center at the Ohio State University in Columbus, Columbus, OH
| | - Michael Essandoh
- Department of Anesthesiology at the Wexner Medical Center at the Ohio State University in Columbus, Columbus, OH
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22
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Guo Z, Li C, Cao Y, Jiang L, Zhang Y, Li P, Zhou Y, Duan C, Hu J, Lu H. 3D visualization and morphometric analysis of spinal motion segments and vascular networks: A synchrotron radiation-based micro-CT study in mice. J Anat 2022; 240:268-278. [PMID: 34622448 PMCID: PMC8742973 DOI: 10.1111/joa.13556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 08/08/2021] [Accepted: 09/14/2021] [Indexed: 11/28/2022] Open
Abstract
The structure of spinal motion segments and spinal vasculature is complicated. Visualizing the three-dimensional (3D) structure of the spine may provide guidance for spine surgery. However, conventional imaging techniques fail to simultaneously obtain 3D images of soft and hard tissues, and achieving such coimaging states of the spine and its vascular networks remains a challenge. Synchrotron radiation micro-CT (SRμCT) provides a relatively effective and novel method of acquiring detailed 3D information. In this study, specimens of the thoracic spine were obtained from six mice. SRμCT was employed to acquire 3D images of the structure, and histologic staining was performed for comparisons with the SRμCT images. The whole spinal motion segments and the spinal vascular network were simultaneously explored at high resolution. The mean thickness of the cartilaginous end plates (CEPs) and the volume of the intervertebral discs (IVDs) were calculated. The surface of the CEPs and the facet joint cartilage (FJC) were presented as heat maps, which allowed for direct visualization of the thickness distribution. Regional division revealed heterogeneity among the ventral, central, and dorsal parts of the CEPs and between the superior and inferior parts of the facet processes. Moreover, the connections and spatial morphology of the spinal vascular network were visualized. Our study indicates that SRμCT imaging is an ideal method for high-resolution visualization and 3D morphometric analysis of the whole spinal motion segments and spinal vascular network.
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Affiliation(s)
- Zhu Guo
- Department of Spine Surgery and OrthopaedicsXiangya HospitalCentral South UniversityChangshaChina
- Spine Surgery Department of the Affiliated Hospital of Qingdao UniversityQingdaoChina
| | - Chengjun Li
- Department of Spine Surgery and OrthopaedicsXiangya HospitalCentral South UniversityChangshaChina
- National Clinical Research Center for Geriatric DisordersXiangya HospitalCentral South UniversityChangshaChina
- Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan ProvinceChangshaChina
| | - Yong Cao
- Department of Spine Surgery and OrthopaedicsXiangya HospitalCentral South UniversityChangshaChina
- National Clinical Research Center for Geriatric DisordersXiangya HospitalCentral South UniversityChangshaChina
- Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan ProvinceChangshaChina
| | - Liyuan Jiang
- Department of Spine Surgery and OrthopaedicsXiangya HospitalCentral South UniversityChangshaChina
- National Clinical Research Center for Geriatric DisordersXiangya HospitalCentral South UniversityChangshaChina
- Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan ProvinceChangshaChina
| | - Yi Zhang
- Department of Sports MedicineAffiliated Hospital of Qingdao UniversityQingdaoChina
- Traumatic Orthopaedic Institute of Shandong ProvinceAffiliated Hospital of Qingdao UniversityQingdaoChina
| | - Ping Li
- Department of ObstetricsXiangya HospitalCentral South UniversityChangshaChina
| | - Yongchun Zhou
- Department of OrthopedicShanxi Provincial People’s HospitalXi’anChina
| | - Chunyue Duan
- Department of Spine Surgery and OrthopaedicsXiangya HospitalCentral South UniversityChangshaChina
- National Clinical Research Center for Geriatric DisordersXiangya HospitalCentral South UniversityChangshaChina
| | - Jianzhong Hu
- Department of Spine Surgery and OrthopaedicsXiangya HospitalCentral South UniversityChangshaChina
- National Clinical Research Center for Geriatric DisordersXiangya HospitalCentral South UniversityChangshaChina
- Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan ProvinceChangshaChina
| | - Hongbin Lu
- Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan ProvinceChangshaChina
- Department of Sports MedicineResearch Centre of Sports MedicineXiangya HospitalCentral South UniversityChangshaChina
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23
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Moazeni Y, Cantrell DR, Clark JR, Abdalla RN, Batra A, Hurley MC, Ansari SA, Russell EJ, Shaibani A. Case Report: Anterior Spinal Cord Ischemia Following Embolization of Cerebellar Arteriovenous Malformation: An Illustrative Case and Review of Spinal Cord Vascular Anatomy. Front Neurol 2021; 12:725065. [PMID: 34557153 PMCID: PMC8452862 DOI: 10.3389/fneur.2021.725065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 08/11/2021] [Indexed: 12/03/2022] Open
Abstract
Spinal cord ischemia (SCI) is a rare entity with high mortality and morbidity which can arise from causes such as atherosclerosis, aortic dissection or aneurysm, thromboembolic events or systemic hypotension, and is a potential complication of spinal surgery. Published literature contains very few reports of SCI as a complication of intracranial interventions, highlighting the uncommon nature of SCI in these circumstances. We report the occurrence of anterior SCI in a 69-year-old patient following successful embolization of a cerebellar arteriovenous malformation (AVM), marked by upper extremity weakness, lower extremity paraplegia, loss of bladder and bowel control, and hypercapnic respiratory failure requiring mechanical ventilation. Magnetic resonance imaging (MRI) demonstrated upper cervical diffusion restriction and T2/STIR hyperintensity. Unusually, SCI occurred in this case without intraprocedural catheter wedging or obvious flow limitation, prolonged procedure time, hypercoagulable state, or general hypotension. We review previous cases in the literature as well as spinal cord vascular anatomy, and discuss the possible etiologies of this complication. Spinal cord ischemia could be a very rare complication of neuroendovascular procedures even in the absence of warning signs and should be carefully evaluated in patients with suspected neurologic symptoms after such procedures.
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Affiliation(s)
- Yasaman Moazeni
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Donald R Cantrell
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Jeffrey R Clark
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Ramez N Abdalla
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Ayush Batra
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Michael C Hurley
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Sameer A Ansari
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Eric J Russell
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Ali Shaibani
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
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24
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Nuñez M, Guillotte A, Faraji AH, Deng H, Goldschmidt E. Blood supply to the corticospinal tract: A pictorial review with application to cranial surgery and stroke. Clin Anat 2021; 34:1224-1232. [PMID: 34478213 DOI: 10.1002/ca.23782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 08/27/2021] [Accepted: 09/01/2021] [Indexed: 12/18/2022]
Abstract
The corticospinal tract (CST) is the main neural pathway responsible for conducting voluntary motor function in the central nervous system. The CST condenses into fiber bundles as it descends from the frontoparietal cortex, traveling down to terminate at the anterior horn of the spinal cord. The CST is at risk of injury from vascular insult from strokes and during neurosurgical procedures. The aim of this article is to identify and describe the vasculature associated with the CST from the cortex to the medulla. Dissection of cadaveric specimens was carried out in a manner, which exposed and preserved the fiber tracts of the CST, as well as the arterial systems that supply them. At the level of the motor cortex, the CST is supplied by terminal branches of the anterior cerebral artery and middle cerebral artery. The white matter tracts of the corona radiata and internal capsule are supplied by small perforators including the lenticulostriate arteries and branches of the anterior choroidal artery. In the brainstem, the CST is supplied by anterior perforating branches from the basilar and vertebral arteries. The caudal portions of the CST in the medulla are supplied by the anterior spinal artery, which branches from the vertebral arteries. The non-anastomotic nature of the vessel systems of the CST highlights the importance of their preservation during neurosurgical procedures. Anatomical knowledge of the CST is paramount to clinical diagnosis and treatment of heterogeneity of neurodegenerative, neuroinflammatory, cerebrovascular, and skull base tumors.
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Affiliation(s)
- Maximilano Nuñez
- Hospital El Cruce, Buenos Aires University Medical School, Florencio Varela, Argentina
| | - Andrew Guillotte
- University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Amir H Faraji
- Department of Neurosurgery, Houston Methodist, Houston, Texas, USA
| | - Hansen Deng
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Ezequiel Goldschmidt
- Department of Neurosurgery, University of California San Francisco, San Francisco, California, USA
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25
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Awad H, Raza A, Saklayen S, Bhandary S, Kelani H, Powers C, Bourekas E, Stine I, Milner R, Valentine E, Essandoh M. Combined Stroke and Spinal Cord Ischemia in Hybrid Type I Aortic Arch Debranching and TEVAR and the Dual Role of the Left Subclavian Artery. J Cardiothorac Vasc Anesth 2021; 36:3687-3700. [PMID: 34538558 DOI: 10.1053/j.jvca.2021.08.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 08/20/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Hamdy Awad
- Department of Anesthesiology at the Wexner Medical Center at the Ohio State University, Columbus, OH.
| | - Arwa Raza
- Ohio State University College of Medicine, Columbus, OH
| | - Samiya Saklayen
- Department of Anesthesiology at the Wexner Medical Center at the Ohio State University, Columbus, OH
| | - Sujatha Bhandary
- Department of Anesthesiology at Emory University School of Medicine, Atlanta, GA
| | - Hesham Kelani
- Department of Anesthesiology at the Wexner Medical Center at the Ohio State University, Columbus, OH
| | - Ciaran Powers
- Department of Neurosurgery at the Wexner Medical Center at the Ohio State University, Columbus, OH
| | - Eric Bourekas
- Department of Radiology at Wexner Medical Center at the Ohio State University, Columbus, OH
| | - Ian Stine
- Department of Surgery at the University of Chicago, Chicago, IL
| | - Ross Milner
- Department of Surgery at the University of Chicago, Chicago, IL
| | - Elizabeth Valentine
- Department of Anesthesiology and Critical Care, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Michael Essandoh
- Department of Anesthesiology at the Wexner Medical Center at the Ohio State University, Columbus, OH
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26
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Meyer BP, Hirschler L, Lee S, Kurpad SN, Warnking JM, Barbier EL, Budde MD. Optimized cervical spinal cord perfusion MRI after traumatic injury in the rat. J Cereb Blood Flow Metab 2021; 41:2010-2025. [PMID: 33509036 PMCID: PMC8327111 DOI: 10.1177/0271678x20982396] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 10/11/2020] [Accepted: 11/22/2020] [Indexed: 11/17/2022]
Abstract
Despite the potential to guide clinical management of spinal cord injury and disease, noninvasive methods of monitoring perfusion status of the spinal cord clinically remain an unmet need. In this study, we optimized pseudo-continuous arterial spin labeling (pCASL) for the rodent cervical spinal cord and demonstrate its utility in identifying perfusion deficits in an acute contusion injury model. High-resolution perfusion sagittal images with reduced imaging artifacts were obtained with optimized background suppression and imaging readout. Following moderate contusion injury, perfusion was clearly and reliably decreased at the site of injury. Implementation of time-encoded pCASL confirmed injury site perfusion deficits with blood flow measurements corrected for variability in arterial transit times. The noninvasive protocol of pCASL in the spinal cord can be utilized in future applications to examine perfusion changes after therapeutic interventions in the rat and translation to patients may offer critical implications for patient management.
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Affiliation(s)
- Briana P Meyer
- Department of Neurosurgery, Medical College of Wisconsin,
Milwaukee, WI, USA
- Biophysics Graduate Program, Medical College of Wisconsin,
Milwaukee, WI, USA
- Neuroscience Doctoral Program, Medical College of Wisconsin,
Milwaukee, WI, USA
| | - Lydiane Hirschler
- Univ. Grenoble Alpes, Inserm, U1216, Grenoble Institut des
Neurosciences, Grenoble, France
- Department of Radiology, C.J. Gorter Center for High Field MRI,
Leiden University Medical Center, Leiden, the Netherlands
| | - Seongtaek Lee
- Department of Neurosurgery, Medical College of Wisconsin,
Milwaukee, WI, USA
- Biomedical Engineering Graduate Program, Marquette University
& Medical College of Wisconsin, Milwaukee, WI, USA
| | - Shekar N Kurpad
- Department of Neurosurgery, Medical College of Wisconsin,
Milwaukee, WI, USA
| | - Jan M Warnking
- Univ. Grenoble Alpes, Inserm, U1216, Grenoble Institut des
Neurosciences, Grenoble, France
| | - Emmanuel L Barbier
- Univ. Grenoble Alpes, Inserm, U1216, Grenoble Institut des
Neurosciences, Grenoble, France
| | - Matthew D Budde
- Department of Neurosurgery, Medical College of Wisconsin,
Milwaukee, WI, USA
- Clement J Zablocki Veteran's Affairs Medical Center, Milwaukee,
WI, USA
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Schmidt A, Hempel JM, Ellerkamp V, Warmann SW, Ernemann U, Fuchs J. The Relevance of Preoperative Identification of the Adamkiewicz Artery in Posterior Mediastinal Pediatric Tumors. Ann Surg Oncol 2021; 29:493-499. [PMID: 34331163 PMCID: PMC8677641 DOI: 10.1245/s10434-021-10381-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 06/11/2021] [Indexed: 11/18/2022]
Abstract
Background Injury to the artery of Adamkiewicz (AKA) during surgery may lead to spinal cord ischemia and severe neurologic complications. Posterior mediastinal tumors may be adjacent to AKA, but data on preoperative visualization of AKA in children are rare. This study analyzed the importance of identifying the AKA preoperatively by spinal digital subtraction angiography (DSA) in children with posterior mediastinal tumors for therapeutic procedure. Methods Between 2002 and 2021, 36 children with posterior mediastinal tumors were evaluated for surgery at the authors’ clinic. In 10 children with left-sided or bilateral tumor located at vertebral levels T8 to L1, spinal DSA was performed during preoperative workup to assess AKA. The patient and tumor characteristics as well as the diagnostic and therapeutic procedures were analyzed. Results The median age of the 10 children at examination was 69 months (range, 16–217 months). Three of the children were younger than 2 years. The tumor entities were neuroblastoma, ganglioneuroblastoma, ganglioneuroma, local relapse of a hepatocellular carcinoma, and neurofibroma. The AKA was identified in all cases, and proximity to the tumor was detected in four patients, three of whom had their planned surgery changed to irradiation. No complications occurred during spinal DSA or surgery. Conclusions In posterior mediastinal pediatric tumors, spinal DSA is a safe and reliable method for preoperative visualization of the AKA. It can show proximity to the tumor and guide the local therapy, thereby avoiding critical intra- and postoperative situations.
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Affiliation(s)
- Andreas Schmidt
- Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital, Eberhard Karls University Tuebingen, Tübingen, Germany
| | - Johann-Martin Hempel
- Department of Diagnostic and Interventional Neuroradiology, University Hospital, Eberhard Karls University Tuebingen, Tübingen, Germany
| | - Verena Ellerkamp
- Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital, Eberhard Karls University Tuebingen, Tübingen, Germany
| | - Steven W Warmann
- Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital, Eberhard Karls University Tuebingen, Tübingen, Germany
| | - Ulrike Ernemann
- Department of Diagnostic and Interventional Neuroradiology, University Hospital, Eberhard Karls University Tuebingen, Tübingen, Germany
| | - Jörg Fuchs
- Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital, Eberhard Karls University Tuebingen, Tübingen, Germany.
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Spinal vascular lesions: anatomy, imaging techniques and treatment. Eur J Radiol Open 2021; 8:100369. [PMID: 34307789 PMCID: PMC8283341 DOI: 10.1016/j.ejro.2021.100369] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/23/2021] [Accepted: 07/04/2021] [Indexed: 11/23/2022] Open
Abstract
Vascular myelopathies include different aetiology and mechanism of damage. The level of the lesion and the localization within the SC correlates with the clinical symptoms. CT, MRI and angiography are essential for diagnosis and treatment playing a complementary role. MRI is the gold standard for the evaluation of spinal cord lesions. Spinal angiography is the gold standard for evaluation of spinal cord vasculature and vascular malformations.
Background Vascular lesions of the spinal cord are rare but potentially devastating conditions whose accurate recognition critically determines the clinical outcome. Several conditions lead to myelopathy due to either arterial ischemia, venous congestion or bleeding within the cord. The clinical presentation varies, according with the different aetiology and mechanism of damage. Purpose The aim is to provide a comprehensive review on the radiological features of the most common vascular myelopathies, passing through the knowledge of the vascular spinal anatomy and the clinical aspects of the different aetiologies, which is crucial to promptly address the diagnosis and the radiological assessment.
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29
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McEntire CR, Dowd RS, Orru' E, David C, Small JE, Cervantes-Arslanian A, Lerner DP. Acute Myelopathy: Vascular and Infectious Diseases. Neurol Clin 2021; 39:489-512. [PMID: 33896530 DOI: 10.1016/j.ncl.2021.01.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Vascular and infectious causes are rare but important causes of spinal cord injury. High suspicion for these processes is necessary, as symptoms may progress over hours to days, resulting in delayed presentation and diagnosis and worse outcomes. History and clinical examination findings can assist with localization of the affected vascular territory and spinal level, which will assist with focusing spinal imaging. Open and/or endovascular surgical management depends on the associated vascular abnormality. Infectious myelopathy treatment consists of targeted antimicrobial therapy when possible, infectious source control, and again, close monitoring for systemic complications.
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Affiliation(s)
- Caleb R McEntire
- Department of Neurology, Massachusetts General Hospital and Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Richard S Dowd
- Department of Neurosurgery, Tufts University School of Medicine, Boston, MA 02111, USA
| | - Emanuele Orru'
- Department of Radiology, Neurointerventional Radiology Division, Lahey Hospital and Medical Center, Burlington, MA 01805, USA
| | - Carlos David
- Department of Neurosurgery, Tufts University School of Medicine, Boston, MA 02111, USA; Department of Neurosurgery, Lahey Hospital and Medical Center, Burlington, MA 01805, USA
| | - Juan E Small
- Department of Radiology, Neuroradiology Section, Lahey Hospital and Medical Center, Burlington, MA 01805, USA
| | | | - David P Lerner
- Division of Neurology, Lahey Hospital and Medical Center, Burlington, MA 01805, USA; Department of Neurology, Tufts University School of Medicine, Boston, MA 02111, USA.
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30
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Yu JX, He C, Ye M, Li GL, Bian LS, Yang F, Zhai XD, Ling F, Zhang HQ, Hong T. The efficacy and deficiency of contemporary treatment for spinal cord arteriovenous shunts. Brain 2021; 144:3381-3391. [PMID: 34156437 DOI: 10.1093/brain/awab237] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 05/15/2021] [Accepted: 06/03/2021] [Indexed: 11/12/2022] Open
Abstract
Contemporary treatments for spinal cord arteriovenous shunts are only based on clinicians' treatment experiences and expertise due to its rarity. We reviewed the clinical course of the largest multi-cantered cohort to evaluate the efficacy and deficiency of contemporary interventional treatments for spinal cord arteriovenous shunts. The clinical features, treatment results and clinical outcomes of 463 spinal cord arteriovenous shunts patients were retrospectively assessed. The main outcome was the neurological deterioration that was evaluated based on the modified Aminoff and Logue scale. According to post-treatment DSA, complete obliteration was defined as disappearance of the intradural lesion, whereas partial obliteration was defined as any residual intradural lesion remaining visible and was further categorized as shunt-reduction obliteration (the nidus or shunt points was reduced) or palliative obliteration (only obliterated aneurysms or feeders). Cure rate was 40.6% for whole cohort, 58.5% after microsurgery, and 26.4% after embolization. The curative resection was associated with non-metameric lesions, lesions with a maximum diameter < 3 cm and lesions without anterior sulcal artery supply. The curative embolization was associated with fistula-type lesions, non-metameric lesions, and main drainage diameter < 1.5 mm. Permanent treatment-related neurological deficits rate was 11.2% for the whole cohort, 16.1% after microsurgery, and 5.6% after embolization. The pre-treatment clinical deterioration rate was 32.5%/year, which decreased to 9.3%/year after clinical interventions. After partial treatment, the long-term acute and gradual deterioration rate were 5.3%/year and 3.6%/year, respectively. The acute deteriorations were associated with metameric lesions, craniocervical lesions, lesions with a maximum diameter ≥2 cm and residual aneurysm. Residual aneurysm was the only predictor of acute deterioration for non-metameric spinal cord arteriovenous shunts. The gradual deteriorations were associated with palliative obliteration, absence of pre-treatment acute deterioration and intact main drainage. Although clinical risks of spinal cord arteriovenous shunts were reduced after clinical interventions, contemporary treatments for spinal cord arteriovenous shunt remains associated with considerable risks and incomplete efficacy. Individualized treatment plans should be adopted according to the angioarchitectural features and major clinical risks of specific lesions. There is a higher opportunity for complete obliteration for lesions with simple angioarchitecture. However, regarding most of spinal cord arteriovenous shunts with complex vascular anatomy, partial treatment is the only choice. For these patients, palliative obliteration targeting the aneurysms is recommended for reducing hemorrhagic risk, whereas shunt-reduction obliteration is necessary for non-haemorrhagic myelopathy. Contemporary treatment is ineffective in reducing hemorrhagic risk of incurable metameric spinal cord arteriovenous shunts.
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Affiliation(s)
- Jia-Xing Yu
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.,International Neuroscience Institute (China-INI), Beijing, China
| | - Chuan He
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.,International Neuroscience Institute (China-INI), Beijing, China
| | - Ming Ye
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.,International Neuroscience Institute (China-INI), Beijing, China
| | - Gui-Lin Li
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.,International Neuroscience Institute (China-INI), Beijing, China
| | - Li-Song Bian
- Department of Neurosurgery, Beijing Haidian Hospital, Beijing, China
| | - Fan Yang
- Department of Neurosurgery, Beijing United Family Hospital, Beijing, China
| | - Xiao-Dong Zhai
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.,International Neuroscience Institute (China-INI), Beijing, China
| | - Feng Ling
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.,International Neuroscience Institute (China-INI), Beijing, China
| | - Hong-Qi Zhang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.,International Neuroscience Institute (China-INI), Beijing, China
| | - Tao Hong
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.,International Neuroscience Institute (China-INI), Beijing, China
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Kachlik D, Musil V, Blankova A, Marvanova Z, Miletin J, Trachtova D, Dvorakova V, Baca V. A plea for extension of the anatomical nomenclature: Vessels. Bosn J Basic Med Sci 2021; 21:208-220. [PMID: 33259774 PMCID: PMC7982069 DOI: 10.17305/bjbms.2020.5256] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 11/11/2020] [Indexed: 12/20/2022] Open
Abstract
This article is the fourth and last part of a series aimed at extending and correcting the anatomical nomenclature. Because of the rapid development of internet and the use of electronic formats in communication in anatomy, embryology, histology, medical education, and clinical medicine, an appropriate, precise, and concise anatomical nomenclature is required. Such tool enables to avoid any potential confusion and possible scientific/medical mistakes. The up-to-date official anatomical terminology, Terminologia Anatomica, is available longer than 20 years and needs to be refined and extended. The authors have collected and listed 210 terms and completed them with definitions and/or explanations. We aimed to start a discussion about their potential incorporation into the new revised version of the Terminologia Anatomica. This article is primarily focused on the vessels of the human body (arteries, veins, and lymphatic system).
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Affiliation(s)
- David Kachlik
- Department of Anatomy, Second Faculty of Medicine, Charles University, Prague, Czech Republic; Department of Health Care Studies, College of Polytechnics Jihlava, Jihlava, Czech Republic
| | - Vladimir Musil
- Centre of Scientific Information, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Alzbeta Blankova
- Department of Anatomy, Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Zuzana Marvanova
- Department of Anatomy, Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jakub Miletin
- Department of Anatomy, Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Daniela Trachtova
- Department of Anatomy, Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Vlasta Dvorakova
- Department of Health Care Studies, College of Polytechnics Jihlava, Jihlava, Czech Republic
| | - Vaclav Baca
- Department of Health Care Studies, College of Polytechnics Jihlava, Jihlava, Czech Republic
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32
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Chen G, Wei F, Li J, Shi L, Zhang W, Wang X, Xu Z, Liu X, Zou X, Liu S. Intensity of Intraoperative Spinal Cord Hyperechogenicity as a Novel Potential Predictive Indicator of Neurological Recovery for Degenerative Cervical Myelopathy. Korean J Radiol 2021; 22:1163-1171. [PMID: 33739631 PMCID: PMC8236360 DOI: 10.3348/kjr.2020.0755] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 09/29/2020] [Accepted: 11/03/2020] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE To analyze the correlations between intraoperative ultrasound and MRI metrics of the spinal cord in degenerative cervical myelopathy and identify novel potential predictive ultrasonic indicators of neurological recovery for degenerative cervical myelopathy. MATERIALS AND METHODS Twenty-two patients who underwent French-door laminoplasty for multilevel degenerative cervical myelopathy were followed up for 12 months. The Japanese Orthopedic Association (JOA) scores were assessed preoperatively and 12 months postoperatively. Maximum spinal cord compression and compression rates were measured and calculated using both intraoperative ultrasound imaging and preoperative T2-weight (T2W) MRI. Signal change rates of the spinal cord on preoperative T2W MRI and gray value ratios of dorsal and ventral spinal cord hyperechogenicity on intraoperative ultrasound imaging were measured and calculated. Correlations between intraoperative ultrasound metrics, MRI metrics, and the recovery rate JOA scores were analyzed using Spearman correlation analysis. RESULTS The postoperative JOA scores improved significantly, with a mean recovery rate of 65.0 ± 20.3% (p < 0.001). No significant correlations were found between the operative ultrasound metrics and MRI metrics. The gray value ratios of the spinal cord hyperechogenicity was negatively correlated with the recovery rate of JOA scores (ρ = -0.638, p = 0.001), while the ventral and dorsal gray value ratios of spinal cord hyperechogenicity were negatively correlated with the recovery rate of JOA-motor scores (ρ = -0.582, p = 0.004) and JOA-sensory scores (ρ = -0.452, p = 0.035), respectively. The dorsal gray value ratio was significantly higher than the ventral gray value ratio (p < 0.001), while the recovery rate of JOA-motor scores was better than that of JOA-sensory scores at 12 months post-surgery (p = 0.028). CONCLUSION For degenerative cervical myelopathy, the correlations between intraoperative ultrasound and preoperative T2W MRI metrics were not significant. Gray value ratios of the spinal cord hyperechogenicity and dorsal and ventral spinal cord hyperechogenicity were significantly correlated with neurological recovery at 12 months postoperatively.
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Affiliation(s)
- Guoliang Chen
- Guangdong Provincial Key Laboratory of Orthopaedics and Traumatology/Orthopaedic Research Institute, Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Department of Orthopedic Surgery, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Fuxin Wei
- Department of Orthopedic Surgery, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Jiachun Li
- Department of Orthopedic Surgery, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Liangyu Shi
- Department of Orthopedic Surgery, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Wei Zhang
- Department of Orthopedic Surgery, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Xianxiang Wang
- Department of Ultrasound, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Zuofeng Xu
- Department of Ultrasound, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Xizhe Liu
- Guangdong Provincial Key Laboratory of Orthopaedics and Traumatology/Orthopaedic Research Institute, Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
| | - Xuenong Zou
- Guangdong Provincial Key Laboratory of Orthopaedics and Traumatology/Orthopaedic Research Institute, Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Shaoyu Liu
- Guangdong Provincial Key Laboratory of Orthopaedics and Traumatology/Orthopaedic Research Institute, Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Department of Orthopedic Surgery, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
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33
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Ghani MR, Busa V, Dardeir A, Marudhai S, Patel M, Abdelmoneim YM, Jan A, Eskander N. Mechanical Thrombectomy in Patients With Acute Ischemic Stroke: A Comparison of Transradial Versus Transfemoral Cerebral Angiography. Cureus 2020; 12:e10919. [PMID: 33194486 PMCID: PMC7657371 DOI: 10.7759/cureus.10919] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 10/12/2020] [Indexed: 12/17/2022] Open
Abstract
Stroke is the fourth leading cause of death in the United States and the primary reason for long-term disability. This debilitating condition can be divided into ischemic stroke and hemorrhagic stroke. The former occurs in almost 90% of all cases and arises from the occlusion of the supplying artery. Over the years, the management of stroke has developed from solely medical treatment to that which combines medical with mechanical treatment. Mechanical thrombectomy (MT) has drawn considerable interest in advanced medicine and is becoming more widely available. The two fundamental techniques in opening an occluded vessel are the transfemoral and transradial approaches. This literature review aims to compare the clinical implications, complication rate, and overall outcome between the transfemoral and transradial approaches in endovascular intervention in patients with acute ischemic stroke. We conducted a literature review on ischemic stroke and searched PubMed and Google Scholar for relevant articles published from January 2010 to March 2020. Mechanical thrombectomy has become the standard of care for patients with brain ischemia. The transradial approach exhibited superiority to the transfemoral route in resolving symptoms, decreased complication rates, and reduced healthcare costs in a subset of patients. In this literature review, the comparison between the two procedures reveals that the outcomes for anterior circulation stroke and posterior vascular system stroke may vary. Further research needs to be conducted to improve procedural skills and decrease technical difficulties, ultimately resulting in improved overall patient outcomes with respect to health and comfort.
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Affiliation(s)
- Mohammad R Ghani
- Neurology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Vishal Busa
- Internal Medicine/Family Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Ahmed Dardeir
- Internal Medicine/Family Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
- Department of Physical Medicine and Rehabilitation, Richmond University Medical Center, New York, USA
| | - Suganya Marudhai
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Mauli Patel
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Yousif M Abdelmoneim
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, USA
| | - Ahmad Jan
- Surgery, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
- Department of General Surgery and Emergency Services, International Medical Centre, Jeddah, SAU
| | - Noha Eskander
- Psychiatry, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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34
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Garcia-Ballestas E, Murlimanju BV, Durango-Espinosa YA, Joaquim AF, Vasquez HE, Moscote-Salazar LR, Agrawal A. Collateral Circulation in Spinal Cord Injury: A Comprehensive Review. INDIAN JOURNAL OF NEUROTRAUMA 2020. [DOI: 10.1055/s-0040-1713724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AbstractSurgery is the most common cause of spinal cord ischemia; it is also caused by hemodynamic changes, which disrupt the blood flow. Direct ligation of the spinal arteries, especially the Adamkiewicz artery is involved as well. Other causes of spinal cord ischemia include arteriography procedures, thoracic surgery, epidural and rachianesthesia, foraminal infiltration, arterial dissection, systemic hypotension, emboligenic heart disease, thoracic disc herniation, and compression. Understanding the vascular anatomy of the spinal cord is essential to develop optimal strategies for preventing ischemic injuries to the spinal cord. During ischemia, a rich network of intra and paraspinal collaterals allow enough blood flow to compensate the intensity of spinal cord ischemia. In case of interruption of flow of a main artery, the collateral artery increases its flow to maintain perfusion to the tissues. Avoiding spinal cord ischemia by using collateral circulation is necessary to prevent the establishment of hypovolemia, hyperthermia and elevations in venous pressures. The objective of this narrative review is to present the current concepts of spinal collateral circulation and its role in the setting of ischemic events, affecting the vascular supply of the spinal cord.
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Affiliation(s)
- Ezequiel Garcia-Ballestas
- Faculty of Medicine, Center for Biomedical Research (CIB), University of Cartagena, Cartagena, Colombia
| | - B. V. Murlimanju
- Department of Anatomy, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | | | - Andrei F. Joaquim
- Neurosurgery Division, Cartagena de Indias, Bolivar Department of Neurology, State University of Campinas, Campinas-Sao Paulo, Brazil
| | - Harold E. Vasquez
- Universidad del Sinu, Cartagena de Indias, Consejo Latinoamericano de Neurointensivismo (CLaNi), Cartagena de Indias, Colombia
| | - Luis Rafael Moscote-Salazar
- Neurosurgeon-Critical Care, Center for Biomedical Research (CIB), Cartagena Neurotrauma Research Group, Faculty of Medicine, University of Cartagena, Cartagena, Colombia
| | - Amit Agrawal
- Department of Neurosurgery, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
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35
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Rojas S, Ortega M, Rodríguez-Baeza A. Anatomical study of the pial arterial network in human spinal cords. Clin Anat 2020; 34:596-604. [PMID: 32427384 DOI: 10.1002/ca.23622] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 05/10/2020] [Accepted: 05/10/2020] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Multiple collaterals originate from three main longitudinal vessels to perfuse the human spinal cord. Only a few classic studies published in the last century have investigated these collaterals. The current work proposes a possible classification of these vessels and analyzes their relative abundance along spinal cord segments. MATERIALS AND METHODS Human spinal cords (n = 30) from male and female cadavers were injected with colored latex through the vertebral, ascending cervical, costocervical trunk and segmental arteries and then fixed in formaldehyde solution. Afterwards, spinal vessels were dissected and the relative abundances of each type of collateral were quantified and compared between different spinal cord segments. RESULTS Collaterals of the anterior longitudinal pathway can be classified as central arteries and arteries for the anterior and lateral columns. Collaterals for the anterior column can be classified into two types: anteromedial and anterolateral. Arteries for the lateral column can be classified, according to their relationship with the dentate ligament, as either preligamentous or post-ligamentous. The collaterals of posterior longitudinal pathways can be divided between those for the posterior and those for the lateral column. In turn, the arteries for the posterior column can be classified into three types: median posterior, posteromedial and posterolateral. The collaterals for the lateral column were also classified as either pre- or post-ligamentous. CONCLUSION The relative abundance of the various types of collateral and anastomoses between longitudinal pathways was inhomogeneous along the spinal cord, with several statistically significant differences observed between spinal segments.
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Affiliation(s)
- Santiago Rojas
- Unit of Human Anatomy and Embriology, Department of Morphological Sciences, Faculty of Medicine, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain.,Serra Húnter Fellow, Universtitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
| | - Marisa Ortega
- Unit of Human Anatomy and Embriology, Department of Morphological Sciences, Faculty of Medicine, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain.,Institute of Legal Medicine and Forensic Sciences of Catalonia, Hospitalet de Llobregat, Spain
| | - Alfonso Rodríguez-Baeza
- Unit of Human Anatomy and Embriology, Department of Morphological Sciences, Faculty of Medicine, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
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36
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Cho KT, Yang JJ, Lee K. Intradural Extramedullary Metastatic Conjunctival Malignant Melanoma. World Neurosurg 2020; 138:444-448. [PMID: 32217182 DOI: 10.1016/j.wneu.2020.03.078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 03/12/2020] [Accepted: 03/13/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Intradural extramedullary (IDEM) metastatic spine tumors of nonneurogenic origin, excluding leptomeningeal seeding, are very rare. Most patients with IDEM metastatic spine tumors of nonneurogenic origin have coexisting brain metastasis. We report a case of IDEM metastatic malignant melanoma without antecedent or coexisting brain metastasis. CASE DESCRIPTION A 52-year-old man presented with back pain, numbness in the lower extremities, paraparesis, and residual urine sensation after voiding. The patient had a history of conjunctival melanoma in the left eye and underwent surgical removal 3 years 6 months ago. Whole-spine magnetic resonance imaging showed an IDEM tumor at the T11 and T12 level, with compression of the spinal cord. Total laminectomy and resection of the tumor was performed. Pathology confirmed a malignant melanoma. Postoperatively, adjuvant chemotherapy was performed. Pain and neurologic deficit gradually improved, but complete recovery was not achieved. CONCLUSIONS Although rare, even without brain metastasis, malignant melanoma can cause IDEM metastatic malignant melanoma. For neurologic recovery and maintaining quality of life of the patient, surgical treatment for decompression of the spinal cord and postoperative adjuvant treatment for IDEM metastatic malignant melanoma should be considered unless multiple lesions are present in different parts within the spinal column.
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Affiliation(s)
- Keun-Tae Cho
- Department of Neurosurgery, Dongguk University Ilsan Hospital, Goyang, South Korea.
| | - Jae Jun Yang
- Department of Orthopedic Surgery, Dongguk University Ilsan Hospital, Goyang, South Korea
| | - Kyuho Lee
- Department of Pathology, Dongguk University Ilsan Hospital, Goyang, South Korea
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Saravi B, Wittmann K, Krause S, Puttfarcken L, Siepe M, Göbel U, Beyersdorf F, Kari FA. Analysis of spinal cord blood supply combining vascular corrosion casting and fluorescence microsphere technique: A feasibility study in an aortic surgical large animal model. Clin Anat 2020; 34:527-535. [PMID: 32115761 DOI: 10.1002/ca.23586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 02/17/2020] [Accepted: 02/19/2020] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Spinal cord ischemia after cardiovascular interventions continues to be a devastating problem in modern surgery. The role of intraspinal vascular networks and anterior radiculomedullary arteries (ARMA) in preventing spinal cord ischemia is poorly understood. MATERIALS AND METHODS Landrace pigs (n = 30, 35.1 ± 3.9 kg) underwent a lateral thoracotomy. Fluorescent microspheres were injected into the left atrium and a reference sample was aspirated from the descending aorta. Repeated measurements of spinal cord and renal cortical blood flow from the left and right kidneys with three different microsphere colors in five pigs were taken to validate reproducibility. Spinal cord blood flow to the upper thoracic (T1-T4), mid-thoracic (T5-T8), lower thoracic (T9-T13), and lumbar (L1-L3) levels were determined. After euthanasia, we carried out selective vascular corrosion cast and counted the left and right ARMAs from levels T1-T13. RESULTS Blood flow analysis of the left and right kidneys revealed a strong correlation (r = .94, p < .001). We detected more left than right ARMAs, with the highest prevalence at T4 (p < .05). The mean number of ARMAs was 8 ± 2. Their number in the upper thoracic region ranged from 2 to 7 (mean of 5 ± 1), while in the lower thoracic region they ranged from 0 to 5 (mean of 3 ± 1 [p < .001]). CONCLUSIONS This study shows that combining fluorescence microsphere technique and vascular corrosion cast is well suited for assessing the blood flow and visualizing the arteries at the same time.
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Affiliation(s)
| | - Karin Wittmann
- Cardiovascular Surgery, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Sonja Krause
- Cardiovascular Surgery, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Luisa Puttfarcken
- Cardiovascular Surgery, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Matthias Siepe
- Cardiovascular Surgery, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ulrich Göbel
- Anesthesiology and Intensive Care, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Friedhelm Beyersdorf
- Cardiovascular Surgery, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Fabian A Kari
- Cardiovascular Surgery, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Chen F, Liu X, Qiu T, Jia C, Liu M, Jin Q, Gao P, Li X. Cervical Posterior Spinal Artery Syndrome Caused By Spontaneous Vertebral Artery Dissection: Two Case Reports and Literature Review. J Stroke Cerebrovasc Dis 2020; 29:104601. [PMID: 31917091 DOI: 10.1016/j.jstrokecerebrovasdis.2019.104601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 12/09/2019] [Accepted: 12/10/2019] [Indexed: 10/25/2022] Open
Abstract
Herein, we described 2 patients with posterior spinal artery syndrome (PSAS) caused by vertebral artery dissection. The patients complained of sudden neck pain or walking instability. Neurological examination revealed sensory loss, muscle weakness, and sensory ataxia. Angiography showed double lumen sign or intimal flap in the vertebral artery. T2-weighted imaging and diffusion-weighted imaging of MRI showed a hyperintense lesion in the dorsal side of the cervical spinal cord at different times after onset. Both patients had good outcome after antiplatelet therapy and physiotherapy. A review of previously reported PSAS cases was also conducted in order to improve the understanding and awareness of this rare myelopathy.
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Affiliation(s)
- Futao Chen
- Graduate School, Shandong First Medical University & Shandong Academy of Medical Science, TaiAn, China
| | - Xuemeng Liu
- Department of Neurosurgery, FeiXian People Hospital, FeiXian, China
| | - Tiantian Qiu
- Department of Radiology, LinYi People's Hospital, LinYi, China
| | - Chunxue Jia
- Graduate School, Shandong First Medical University & Shandong Academy of Medical Science, TaiAn, China
| | - Min Liu
- Department of Radiology, LinYi People's Hospital, LinYi, China
| | - Qianxiu Jin
- Department of Radiology, LinYi People's Hospital, LinYi, China
| | - Peihong Gao
- Department of Radiology, JiNing First People's Hospital, JiNing, China
| | - Xiaodong Li
- Department of Radiology, LinYi People's Hospital, LinYi, China.
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Hernandez-Gerez E, Fleming IN, Parson SH. A role for spinal cord hypoxia in neurodegeneration. Cell Death Dis 2019; 10:861. [PMID: 31723121 PMCID: PMC6853899 DOI: 10.1038/s41419-019-2104-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 10/17/2019] [Accepted: 10/21/2019] [Indexed: 01/12/2023]
Abstract
The vascular system of the spinal cord is particularly complex and vulnerable. Damage to the main vessels or alterations to the regulation of blood flow will result in a reduction or temporary cessation of blood supply. The resulting tissue hypoxia may be brief: acute, or long lasting: chronic. Damage to the vascular system of the spinal cord will develop after a traumatic event or as a result of pathology. Traumatic events such as road traffic accidents, serious falls and surgical procedures, including aortic cross-clamping, will lead to an immediate cessation of perfusion, the result of which may not be evident for several days, but may have long-term consequences including neurodegeneration. Pathological events such as arterial sclerosis, venous occlusion and spinal cord compression will result in a progressive reduction of blood flow, leading to chronic hypoxia. While in some situations the initial pathology is exclusively vascular, recent research in neurodegenerative disease has drawn attention to concomitant vascular anomalies in disorders, including amyotrophic lateral sclerosis, spinal muscular atrophy and muscular sclerosis. Understanding the role of, and tissue response to, chronic hypoxia is particularly important in these cases, where inherent neural damage exacerbates the vulnerability of the nervous system to stressors including hypoxia.
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Affiliation(s)
- Elena Hernandez-Gerez
- Institute of Medical Sciences University of Aberdeen Foresterhill Aberdeen, AB25 2ZD, Scotland, UK
| | - Ian N Fleming
- Institute of Medical Sciences University of Aberdeen Foresterhill Aberdeen, AB25 2ZD, Scotland, UK
| | - Simon H Parson
- Institute of Medical Sciences University of Aberdeen Foresterhill Aberdeen, AB25 2ZD, Scotland, UK.
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Padgett M, Abi-Jaoudeh N, Benn BS, Rahimian R, Nelson K. Anterior Cord Syndrome after Embolization for Malignant Hemoptysis. Semin Intervent Radiol 2019; 36:111-116. [PMID: 31123382 DOI: 10.1055/s-0039-1688424] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Interventional radiology plays an integral role in the management of massive and recurrent submassive hemoptysis. Risks of bronchial artery embolization (BAE) are well described and include spinal ischemia and paralysis, most often related to nontarget embolization of the artery of Adamkiewicz or other large radiculomedullary artery supplying the anterior spinal artery. There is increasing literature regarding spinal infarction following BAE when arterial supply to the spinal cord was not evident. The existence of unrecognized patient comorbidities may further contribute to procedural risks.
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Affiliation(s)
- Max Padgett
- Department of Radiological Sciences, University of California, Irvine, California
| | - Nadine Abi-Jaoudeh
- Department of Radiological Sciences, University of California, Irvine, California
| | - Bryan S Benn
- Department of Medicine, University of California, Los Angeles, California
| | - Ramin Rahimian
- Department of Anesthesia, University of California, Irvine, California
| | - Kari Nelson
- Department of Radiological Sciences, University of California, Irvine, California
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Jiang S, Chen W, Shen YD, Qiu YQ, Yu AP, Xu WD. C7 transfer in a posterior intradural approach for treating hemiplegic upper-limbs: hypothesis and a cadaver feasibility study. Br J Neurosurg 2019; 33:413-417. [PMID: 30681010 DOI: 10.1080/02688697.2018.1552754] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: Contralateral C7 nerve root transfer surgery has been successfully applied to rescue motor function of a hemiplegic upper extremity in patients with central neurological injury. This surgical technique is challenging, and limited anatomical space makes it difficult to manipulate tissues and may lead to higher complication rates. The authors hypothesis a new surgical route in which cervical nerve roots of both donor and recipient sides are exposed from a posterior intradural approach and neurorrhaphy is performed easily and clearly. The feasibility of this operation is tested in a cadaver model. Methods: A fresh cadaver was placed prone. After a standard midline incision and extensive cervical laminectomy, the dura and arachnoid were widely opened, and the spinal nerve roots of C6, C7, and C8 were exposed bilaterally. Nerve grafting was attempted between pairs of donor and recipient nerve roots on contralateral sides of the spinal cord. After completion of neurorrhaphy, the dura was closed. Results: Precise neurorrhaphy could be performed intradurally between posterior and anterior nerve roots of C7 on both sides. Multiple anastomoses of C7 to various nerve roots on the contralateral side could also be performed within the same surgical field with an interposition nerve graft. Conclusion: The posterior intradural repair idea affords many advantages, the pathway is shorter and more straightforward, which provides more access to multiple nerve roots repair in one surgical field, and is more familiar to many neurosurgeons and spine surgeons. It may potentially be adapted for clinical use.
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Affiliation(s)
- Su Jiang
- a Department of Hand Surgery, Huashan Hospital, Shanghai Medical College, Fudan University , Shanghai , China.,b Department of Hand and Upper Extremity Surgery, Jing'an District Central Hospital , Shanghai , China
| | - Wei Chen
- c Department of Neurosurgery, Jing'an District Central Hospital , Shanghai , China
| | - Yun-Dong Shen
- a Department of Hand Surgery, Huashan Hospital, Shanghai Medical College, Fudan University , Shanghai , China
| | - Yan-Qun Qiu
- b Department of Hand and Upper Extremity Surgery, Jing'an District Central Hospital , Shanghai , China
| | - Ai-Ping Yu
- a Department of Hand Surgery, Huashan Hospital, Shanghai Medical College, Fudan University , Shanghai , China.,b Department of Hand and Upper Extremity Surgery, Jing'an District Central Hospital , Shanghai , China
| | - Wen-Dong Xu
- a Department of Hand Surgery, Huashan Hospital, Shanghai Medical College, Fudan University , Shanghai , China.,b Department of Hand and Upper Extremity Surgery, Jing'an District Central Hospital , Shanghai , China.,d State Key Laboratory of Medical Neurobiology, Collaborative Innovation Center of Brain Science, Fudan University , Shanghai , China.,e Priority Among Priorities of Shanghai Municipal Clinical Medicine Center , Shanghai , China.,f National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University , Shanghai , China
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Arai M. [Lumbosacral radiculoplexus neuropathy with a small intramedullary lesion in posterior spinal cord: a case report]. Rinsho Shinkeigaku 2018; 58:745-749. [PMID: 30487361 DOI: 10.5692/clinicalneurol.cn-001213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We present the unique case of a patient with lumbosacral radiculoplexus neuropathy (LRPN) and a small intramedullary lesion, probably an infarction, in the spinal cord. A previously healthy 58-year-old female developed acute severe pain involving the entire right lower limb, followed by weakness of the right lower limb a few hours later. The patient could not walk and was referred to our clinic. The patient reported no sphincter symptoms. Examination of the cranial nerves and upper limbs revealed no abnormalities. The strength in her right lower limb was reduced to Medical Research Council grade 1-2/5 with depressed tendon reflexes. The muscle power and tendon reflexes were normal in the left lower limb, whereas plantar responses were flexor on both sides. There was moderate sensory loss to light touch, pin-prick, vibration, cold temperature stimulation, and proprioception in the right lower limb. Routine laboratory tests and cerebrospinal fluid were unremarkable as were homocysteine, erythrocyte sedimentation rate, and antinuclear cytoplasmic antibody. The patient was diagnosed with LRPN, and treatment with intravenous immunoglobulin and methylprednisolone elicited favorable effects. After a four-week course of inpatient rehabilitation, the patient regained independent gait with a T-cane. Interestingly, thoracic MRI showed a small area of hyperintensity in the right posterior portion of the spinal cord at the level of T10 spine on diffusion-weighted images. The lesion showed slight hypointensity on the apparent diffusion coefficient map, suggesting acute infarction. Edema in the paraspinal muscles demonstrated by MRI suggested acute denervation caused by a lesion in the posterior rami or anterior roots. Somatosensory evoked potentials demonstrated prolonged N20 peak latency following right posterior tibial nerve stimulation, consistent with a lesion in right S1 and S2 roots. This case illustrates that microvasculitis, a keystone of the LRPN pathophysiology, could involve peripheral perforating arteries of the spinal cord.
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Affiliation(s)
- Motomi Arai
- Department of Neurology, Seirei Mikatahara General Hospital
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The early history of our understanding of the functions of the spinal cord. Childs Nerv Syst 2018; 34:2123-2125. [PMID: 28803338 DOI: 10.1007/s00381-017-3568-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 08/03/2017] [Indexed: 10/19/2022]
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Campero M, Hughes R, Orellana P, Bevilacqua JA, Guiloff RJ. Spinal cord infarction with ipsilateral segmental neuropathic pain and flaccid paralysis. A functional role for human afferent ventral root small sensory fibres. J Neurol Sci 2018; 395:84-87. [PMID: 30300819 DOI: 10.1016/j.jns.2018.09.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 09/27/2018] [Accepted: 09/27/2018] [Indexed: 11/26/2022]
Abstract
This paper illustrates the cases of two patients with an acute onset of right brachial neuropathic pain, flaccid paralysis and contralateral thermal and thermal pain hypoesthesia, without posterior column impairment nor pyramidal signs below the segmental lesion. MRI showed right sided spinal cord infarction, in the anterior spinal artery territory between C1 and C5 in one patient and between C3 and C7 in the other. Contact Heat Evoked Potentials and Quantitative Thermal Sensory testing are consistent with contralateral, but not ipsilateral, spinothalamic tract involvement. Electromyographic results established ipsilateral segmental denervation and somatosensory evoked responses were consistent with dorsal column sparing. Unilateral anterior cervical spinal cord infarction may present with acute ipsilateral segmental neuropathic pain, lower motor neurone-type weakness, contralateral thermoanalgesia and no pyramidal signs. The ipsilateral pain provides novel evidence that in some instances, ventral roots can play a role in nociception in humans. The infarcted territory may result from occlusion of a sulcal commissural artery or a number of more proximal vessels (including a single or duplicated anterior spinal artery, vertebral arteries or feeding radicular arteries).
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Affiliation(s)
- Mario Campero
- Faculad de Medicina, Universidad de Chile, Chile; Hospital Clínico, Universidad de Chile, Chile; Clínica Las Condes, Santiago, Chile.
| | | | | | - Jorge A Bevilacqua
- Faculad de Medicina, Universidad de Chile, Chile; Hospital Clínico, Universidad de Chile, Chile
| | - Roberto J Guiloff
- Faculad de Medicina, Universidad de Chile, Chile; Imperial College, London, UK
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Synchrotron Radiation Imaging Reveals the Role of Estrogen in Promoting Angiogenesis After Acute Spinal Cord Injury in Rats. Spine (Phila Pa 1976) 2018. [PMID: 29529001 DOI: 10.1097/brs.0000000000002629] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN The efficacy of estrogen on vessel angiogenesis in acute spinal cord injury (SCI) in a rat model was evaluated by synchrotron radiation. OBJECTIVE Here, we investigate the change in injured spinal cord vessels and used the synchrotron radiation to investigate the effect of estrogen on vessel angiogenesis and functional recovery in a rat model of SCI. SUMMARY OF BACKGROUND DATA The promotion of angiogenesis after SCI may be a therapeutic target in the treatment of SCI. Estrogen has been reported to improve locomotor recovery after SCI. However, how estrogen regulates angiogenesis in acute SCI and enhances neurological functional recovery has not been fully characterized. METHODS Synchrotron radiation imaging combined with histological methods was used to image angiogenesis in acute spinal cord treatment with estrogen in rats. RESULTS Synchrotron radiation imaging vividly demonstrated three-dimensional vessel changes in the spinal cord after injury. The imaging showed that vessel number, vessel volume fraction, and vessel connectivity value in the groups treated with estrogen after SCI were significantly increased compared to control groups (P < 0.05). Vessel angiogenesis increased in groups treated with estrogen compared with control rats, which was confirmed with histological staining. Estrogen treatment also attenuated the injury-induced lesion area compared with control groups and improved locomotor functional recovery after SCI. CONCLUSION The results indicated that synchrotron radiation is a powerful imaging tool for visualizing angiogenesis after acute SCI. Estrogen treatment exerted a neuroprotective effect on acute SCI treatment by promoting angiogenesis and reducing the injury-induced lesion area could be recommended as a potential preclinical treatment approach for acute SCI. LEVEL OF EVIDENCE N/A.
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Rojas S, Ortega M, RodríGuez‐Baeza A. Variable anatomic configuration of the posterior spinal arteries in humans. Clin Anat 2018; 31:1137-1143. [DOI: 10.1002/ca.23213] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 05/03/2018] [Accepted: 05/09/2018] [Indexed: 11/10/2022]
Affiliation(s)
- Santiago Rojas
- Unit of Human Anatomy and Embryology. Department of Morphological Sciences. Faculty of MedicineUniversitat Autònoma de BarcelonaCerdanyola del VallèsSpain
| | - Marisa Ortega
- Unit of Human Anatomy and Embryology. Department of Morphological Sciences. Faculty of MedicineUniversitat Autònoma de BarcelonaCerdanyola del VallèsSpain
- Institute of Legal Medicine and Forensic Sciences of Catalonia, Hospitalet de Llobregat Spain
| | - Alfonso RodríGuez‐Baeza
- Unit of Human Anatomy and Embryology. Department of Morphological Sciences. Faculty of MedicineUniversitat Autònoma de BarcelonaCerdanyola del VallèsSpain
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House LM, Barrette K, Mattie R, McCormick ZL. Cervical Epidural Steroid Injection. Phys Med Rehabil Clin N Am 2018; 29:1-17. [DOI: 10.1016/j.pmr.2017.08.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Spinal cord. HANDBOOK OF CLINICAL NEUROLOGY 2017. [PMID: 28987187 DOI: 10.1016/b978-0-12-802395-2.00029-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
We first present a brief historic review of developments in the understanding of spinal cord clinical neuroanatomy and neurophysiology over the past 200 years. We then discuss the technical aspects that apply to the examination of the human spinal cord giving details on the interrelations between the spinal cord and the overlying structures, including the meninges and vertebrae. The subsequent discussion focuses on diseases of the spinal cord. Diseases that affect the spinal cord are vascular disease, diseases of spinal column, trauma, developmental abnormalities, central nervous system degenerative disease, inflammatory disease, metabolic and nutritional myelopathies, and tumors. We summarize our knowledge regarding general reactions of spinal cord tissue to disease, in particular Wallerian degeneration of descending/ascending tracts and axonal reaction. Two categories of disease will be covered in depth: vascular disease of the spinal cord, including a review of normal vascular anatomy, and diseases of the vertebral column that can affect the cord secondarily.
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Yu JX, Hong T, Ma YJ, Ling F, Zhang HQ. A New Type of Spinal Epidural Arteriovenous Fistulas Causes Spinal Epidural Hemorrhage: An Analysis of Five Cases and Natural History Consideration. World Neurosurg 2017; 103:371-379. [DOI: 10.1016/j.wneu.2017.04.036] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Revised: 04/03/2017] [Accepted: 04/06/2017] [Indexed: 12/29/2022]
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Myhre SL, Buser Z, Meisel HJ, Brodke DS, Yoon ST, Wang JC, Park JB, Youssef JA. Trends and Cost of Posterior Cervical Fusions With and Without Recombinant Human Bone Morphogenetic Protein-2 in the US Medicare Population. Global Spine J 2017; 7:334-342. [PMID: 28815161 PMCID: PMC5546681 DOI: 10.1177/2192568217699188] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
STUDY DESIGN Retrospective database review. OBJECTIVE To analyze and report the trends and cost of posterior cervical fusions (PCFs) with and without off-label recombinant human bone morphogenetic protein-2 (rhBMP-2) in the Medicare population. METHODS Patient records from the PearlDiver database were retrospectively reviewed from January 1, 2005, to December 31, 2012, to distinguish individuals who underwent a PCF with or without rhBMP-2. Total numbers, incidence, age, gender, geographic region, reimbursement, and length of stay were analyzed and summarized. RESULTS The combined total of non-rhBMP-2 (n = 39 479; 85.51%) and rhBMP-2 PCF (n = 6692; 14.49%) procedures performed between 2005 and 2012 was 46 171. In general, the number of PCFs without rhBMP-2 consistently increased over time, while the number of PCFs with rhBMP-2 had only a slight increase from 2005 to 2012. On average, PCFs without rhBMP-2 were associated with $1197 higher cost than those with rhBMP-2, but the average length of stay was similar (6 days). From 2005 to 2012, the average cost for procedures with and without rhBMP-2 increased by $12 605 and $7291, respectively. The percentage of rhBMP-2 use peaked in 2007 and dwindled until 2010, and declined an additional 2.84% from 2011 to 2012. Multiple age, region, and gender tendencies were observed. CONCLUSIONS To our knowledge, this was the first study to use the PearlDiver database to report incidence and cost trends of PCF procedures. This article provides meaningful trend data on PCFs to surgeons and clinicians, researchers, and patients, as well as functions as a beacon for future research questions.
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Affiliation(s)
- Sue Lynn Myhre
- Spine Colorado, Durango, CO, USA,Sue Lynn Myhre, 1601 E 19th Ave, Suite 3300, Denver, CO 80218, USA.
| | - Zorica Buser
- University of Southern California, Los Angeles, CA, USA
| | | | | | | | | | - Jong-Beom Park
- Uijongbu St Mary’s Hospital, The Catholic University of Korea, Uijongbu, Korea
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