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Wang CX, Cironi K, Mathkour M, Lockwood J, Aysenne A, Iwanaga J, Loukas M, Bui CJ, Dumont AS, Tubbs RS. Anatomical Study of the Posterior Spinal Artery Branches to the Medulla Oblongata. World Neurosurg 2021; 149:e1098-e1104. [PMID: 33422714 DOI: 10.1016/j.wneu.2020.12.161] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 12/28/2020] [Accepted: 12/29/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND The posterior spinal arteries (PSAs), branches of the intracranial segment of the vertebral artery or posterior inferior cerebellar artery, run bilaterally along the spinal cord and are integral to the blood supply primarily to the posterior one third of this structure. However, a less well-described distribution of the PSAs is their supply to the posterior medulla. The purpose of this study is to examine the medullary branches of the PSA anatomically. METHODS We conducted a cadaveric study to evaluate for branches of the PSA supplying the medulla oblongata. RESULTS All 14 sides had medullary branches arising from the PSAs. The average number of branches supplying the medulla oblongata on each side was 6. Most of these branches traveled laterally to anastomose with medullary branches arising from the anterior spinal artery. Additionally, lateral and ascending branches were noted. CONCLUSIONS Physicians who interpret imaging of the craniocervical junction, in particular arteriograms, should be aware of ascending medullary branches arising from the anterior spinal artery. Additionally, neurosurgeons operating this region must be careful in dissecting over the posterior medulla and manipulating the cerebellar tonsils, as in telovelar approaches to the fourth ventricle, in order to avoid iatrogenic injury to these vessels. Additionally, variable stroke patterns involving the vertebral artery or posterior inferior cerebellar artery might include ischemia to the medulla oblongata via PSA branches, and this anatomy should be kept in mind by interventionalists, radiologists, and neurologists alike.
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Affiliation(s)
- Cindy X Wang
- Tulane University School of Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Katherine Cironi
- Tulane University School of Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Mansour Mathkour
- Tulane University & Ochsner Clinic Neurosurgery Program, Tulane University School of Medicine, New Orleans, Louisiana, USA; Neurosurgery Division, Surgery Department, Jazan University School of Medicine, Jazan, KSA
| | - Joseph Lockwood
- Tulane University & Ochsner Clinic Neurosurgery Program, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Aimee Aysenne
- Department of Neurosurgery, Tulane University School of Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Neurology, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Joe Iwanaga
- Department of Neurosurgery, Tulane University School of Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Neurology, Tulane University School of Medicine, New Orleans, Louisiana, USA.
| | - Marios Loukas
- Department of Anatomical Sciences, St. George's University, St. George's, Grenada; Department of Anatomy, University of Warmia and Mazury, Olsztyn, Poland
| | - C J Bui
- Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Aaron S Dumont
- Department of Neurosurgery, Tulane University School of Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - R Shane Tubbs
- Department of Neurosurgery, Tulane University School of Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Neurology, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Structural & Cellular Biology, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Anatomical Sciences, St. George's University, St. George's, Grenada
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