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Yoshikawa K, Shibata T, Iba Y, Ogura K, Misumi S, Kawaharada N. Simultaneous delineation of collateral circulation to Adamkiewicz artery via internal thoracic artery and endoleak with an ultrahigh-resolution computed tomography. J Vasc Surg 2024; 79:1233-1234. [PMID: 37777941 DOI: 10.1016/j.jvs.2023.08.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 08/16/2023] [Indexed: 10/02/2023]
Affiliation(s)
- Kenta Yoshikawa
- Division of Radiology and Nuclear Medicine, Sapporo Medical University Hospital, Sapporo, Hokkaido, Japan.
| | - Tsuyoshi Shibata
- Department of Cardiovascular Surgery, Sapporo Medical University Hospital, Sapporo, Hokkaido, Japan
| | - Yutaka Iba
- Department of Cardiovascular Surgery, Sapporo Medical University Hospital, Sapporo, Hokkaido, Japan
| | - Keishi Ogura
- Division of Radiology and Nuclear Medicine, Sapporo Medical University Hospital, Sapporo, Hokkaido, Japan
| | - Shogo Misumi
- Division of Radiology and Nuclear Medicine, Sapporo Medical University Hospital, Sapporo, Hokkaido, Japan
| | - Nobuyoshi Kawaharada
- Department of Cardiovascular Surgery, Sapporo Medical University Hospital, Sapporo, Hokkaido, Japan
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Zhou Y, Tu TQ, Li JW, He C, Ye M, Li GL, Hu P, Sun LY, Ling F, Zhang HQ, Hong T, Yu JX. Isolated spinal artery aneurysm: etiology, clinical characteristics, and outcomes. J Neurosurg Spine 2024; 40:662-668. [PMID: 38335520 DOI: 10.3171/2023.11.spine23886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 11/29/2023] [Indexed: 02/12/2024]
Abstract
OBJECTIVE Isolated spinal aneurysms (ISAs) are rare causes of subarachnoid hemorrhage (SAH), which encompass a highly heterogeneous group of clinical entities with multifarious pathogeneses, clinical characteristics, and treatment strategies. Therefore, knowledge about the ISAs remains inadequate. In this study, the authors present a comprehensive analysis of clinical data associated with ISAs at their institutions to enhance the understanding of this disease. METHODS Patients with ISAs confirmed by spinal angiography or surgery at the authors' institutions between 2015 and 2022 were included. Data regarding clinical presentation, lesion location, aneurysm morphology, comorbidities, treatment results, and clinical outcomes were reviewed. RESULTS Seven patients with ISAs were included in the study. Among them, 4 patients (57.1%) experienced severe headache, and 3 patients (42.9%) reported sudden-onset back pain. Additionally, lower-extremity weakness and urinary retention were observed in 2 of these patients (28.6%). Four of the aneurysms exhibited fusiform morphology, whereas the remaining were saccular. All saccular aneurysms in this series were attributed to hemodynamic factors. Conservative treatment was administered to 3 patients, 2 of whom underwent follow-up digital subtraction angiography, which showed spontaneous occlusion of both aneurysms. Four patients ultimately underwent invasive treatments, including 2 who underwent microsurgery and 2 who received endovascular embolization. One patient died of recurrent SAH, while the remaining 6 patients had a favorable prognosis at the latest follow-up assessment. CONCLUSIONS The morphology of aneurysms may be associated with their etiology. Saccular ISAs are usually caused by pressure due to abnormally increased blood flow, whereas fusiform lesions may be more likely to be secondary to vessel wall damage. The authors found that a saccular spinal aneurysm in young patients with a significant dilated parent artery may be a vestige of spinal cord arteriovenous shunts. ISAs can be managed by surgical, endovascular, or conservative procedures, and the clinical outcome is generally favorable. However, the heterogeneous nature of the disease necessitates personalized treatment decision-making based on specific clinical features of each patient.
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Affiliation(s)
- Yuan Zhou
- 1Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; and
- 2International Neuroscience Institute (China-INI), Beijing, China
| | - Tian-Qi Tu
- 1Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; and
- 2International Neuroscience Institute (China-INI), Beijing, China
| | - Jing-Wei Li
- 1Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; and
- 2International Neuroscience Institute (China-INI), Beijing, China
| | - Chuan He
- 1Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; and
- 2International Neuroscience Institute (China-INI), Beijing, China
| | - Ming Ye
- 1Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; and
- 2International Neuroscience Institute (China-INI), Beijing, China
| | - Gui-Lin Li
- 1Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; and
- 2International Neuroscience Institute (China-INI), Beijing, China
| | - Peng Hu
- 1Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; and
- 2International Neuroscience Institute (China-INI), Beijing, China
| | - Li-Yong Sun
- 1Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; and
- 2International Neuroscience Institute (China-INI), Beijing, China
| | - Feng Ling
- 1Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; and
- 2International Neuroscience Institute (China-INI), Beijing, China
| | - Hong-Qi Zhang
- 1Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; and
- 2International Neuroscience Institute (China-INI), Beijing, China
| | - Tao Hong
- 1Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; and
- 2International Neuroscience Institute (China-INI), Beijing, China
| | - Jia-Xing Yu
- 1Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; and
- 2International Neuroscience Institute (China-INI), Beijing, China
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3
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Caulier-Cisterna R, Appelgren-Gonzáles JP, Oyarzún JE, Valenzuela F, Sitaram R, Eblen-Zajjur A, Uribe S. Comparison of LED- and LASER-based fNIRS technologies to record the human peri‑spinal cord neurovascular response. Med Eng Phys 2024; 127:104170. [PMID: 38692767 DOI: 10.1016/j.medengphy.2024.104170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 03/13/2024] [Accepted: 04/11/2024] [Indexed: 05/03/2024]
Abstract
Recently, functional Near-Infrared Spectroscopy (fNIRS) was applied to obtain, non-invasively, the human peri‑spinal Neuro-Vascular Response (NVR) under a non-noxious electrical stimulation of a peripheral nerve. This method allowed the measurements of changes in the concentration of oxyhemoglobin (O2Hb) and deoxyhemoglobin (HHb) from the peri‑spinal vascular network. However, there is a lack of clarity about the potential differences in perispinal NVR recorded by the different fNIRS technologies currently available. In this work, the two main noninvasive fNIRS technologies were compared, i.e., LED and LASER-based. The recording of the human peri‑spinal NVR induced by non-noxious electrical stimulation of a peripheral nerve was recorded simultaneously at C7 and T10 vertebral levels. The amplitude, rise time, and full width at half maximum duration of the perispinal NVRs were characterized in healthy volunteers and compared between both systems. The main difference was that the LED-based system shows about one order of magnitude higher values of amplitude than the LASER-based system. No statistical differences were found for rise time and for duration parameters (at thoracic level). The comparison of point-to-point wave patterns did not show significant differences between both systems. In conclusion, the peri‑spinal NRV response obtained by different fNIRS technologies was reproducible, and only the amplitude showed differences, probably due to the power of the system which should be considered when assessing the human peri‑spinal vascular network.
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Affiliation(s)
- Raúl Caulier-Cisterna
- Department of Informatics and Computing, Faculty of Engineering, Universidad Tecnológica Metropolitana, Santiago, Chile.
| | - Juan-Pablo Appelgren-Gonzáles
- Center for Biomedical Imaging, the Radiology Department, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Juan-Esteban Oyarzún
- Center for Biomedical Imaging, the Radiology Department, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile; Millennium Institute for Intelligent Healthcare Engineering, iHEALTH, Santiago, Chile
| | - Felipe Valenzuela
- Center for Biomedical Imaging, the Radiology Department, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Ranganatha Sitaram
- Diagnostic Imaging Department, Multimodal Functional Brain Imaging and Neurorehabilitation Hub, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Antonio Eblen-Zajjur
- Translational Neuroscience Laboratory, Facultad de Medicina, Universidad Diego Portales, Santiago, Chile
| | - Sergio Uribe
- Department of Medical Imaging and Radiation Sciences, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia.
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Saway BF, Courtney J, Barley J, Frankel B, Hofstetter C, Kalhorn S. Contrast enhanced ultrasound for traumatic spinal cord injury: an overview of current and future applications. Spinal Cord Ser Cases 2024; 10:31. [PMID: 38664470 PMCID: PMC11045808 DOI: 10.1038/s41394-024-00644-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 04/08/2024] [Accepted: 04/17/2024] [Indexed: 04/28/2024] Open
Abstract
STUDY DESIGN Systematic review. OBJECTIVE Contrast-enhanced ultrasound (CEUS) is an imaging modality that has only recently seen neurosurgical application. CEUS uses inert microbubbles to intraoperatively visualize vasculature and perfusion of the brain and spinal cord in real time. Observation and augmentation of spinal cord perfusion is vital component of the management of traumatic spinal cord injury, yet there are limited imaging modalities to evaluate spinal cord perfusion. CEUS provides an intraoperative imaging tool to evaluate spinal cord perfusion in real time. The objective of this review is to evaluate the current literature on the various applications and benefits of CEUS in traumatic spinal cord injury. SETTING South Carolina, USA. METHODS This review was written according to the PRISMA 2020 guidelines. RESULTS 143 articles were found in our literature search, with 46 of them being unique. After excluding articles for relevance to CEUS and spinal cord injury, we were left with 10 papers. Studies in animal models have shown CEUS to be an effective non-invasive imaging modality that can detect perfusion changes of injured spinal cords in real time. CONCLUSION This imaging modality can provide object perfusion data of the nidus of injury, surrounding penumbra and healthy neural tissue in a traumatized spinal cord. Investigation in its use in humans is ongoing and remains promising to be an effective diagnostic and prognostic tool for those suffering from spinal cord injury.
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Affiliation(s)
- Brian Fabian Saway
- Medical University of South Carolina, Department of Neurosurgery, Charleston, SC, 29425, USA.
| | - James Courtney
- Florida State University College of Medicine, Tallahassee, FL, 32303, USA
| | - Jessica Barley
- Medical University of South Carolina, Department of Neurosurgery, Charleston, SC, 29425, USA
| | - Bruce Frankel
- Southern Illinois University School of Medicine, Department of Neurosurgery, Springfield, IL, 62702, USA
| | | | - Stephen Kalhorn
- Medical University of South Carolina, Department of Neurosurgery, Charleston, SC, 29425, USA
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5
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Dong HR, Yu JJ, Chen XY, Xu KL, Xie R. [Application of super-resolution and ultrafast ultrasound to reveal the characteristics of vascular blood flow changes after rat spinal cord injury at different segments]. Zhonghua Yi Xue Za Zhi 2024; 104:690-694. [PMID: 38418168 DOI: 10.3760/cma.j.cn112137-20231020-00830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 03/01/2024]
Abstract
Objective: To investigate the changes of spinal vascular blood flow in SD rats after cervical, thoracic and lumbar spinal cord injury (SCI) using super-resolution ultrafast ultrasound technology. Methods: A total of 9 SD rats were used to construct SCI models at different segments using a 50 g aneurysm clip. Super-resolution ultrafast ultrasound technology was used to perform vascular blood flow imaging on the spinal cord of rats before and after injury at 6 hours, obtaining quantitative information such as spinal cord vascular density and blood flow velocity. Results: Ultrasound imaging showed that after SCI, the vascular density in the thoracic segment decreased (18.16%±1.04%) more than in the cervical segment (11.42%±1.39%) and lumbar segment (13.88%±1.43%, both P<0.05). The length of the spinal cord with decreased vascular density in the thoracic segment [(4.80±0.34)mm] was longer than that in the cervical segment [(2.80±0.57)mm] and lumbar segment [(3.10±0.36)mm, both P<0.05]. After injury, the decrease of blood flow in the thoracic segment [(8.87±0.85)ml/min] was higher than that in the cervical segment [(4.88±0.56)ml/min] and lumbar segment [(6.19±0.71)ml/min, both P<0.05]. HE staining and Nissl staining showed that the proportion of cavity area after thoracic SCI (11.53%±0.93%) was higher than that in the cervical segment (4.90%±1.72%) and lumbar segment (7.64%±0.84%, both P<0.05). The number of Nissl bodies in the thoracic segment (18.0±5.3) was also lower than that in the cervical segment (32.3±5.1) and lumbar segment (37.0±5.6) (both P<0.05). Conclusions: There are different changes in vascular blood flow after SCI in different segments of rats. The same injury causes the most severe damage to blood vessels in the thoracic spinal cord, followed by the lumbar spinal cord, and the cervical spinal cord has the least damage.
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Affiliation(s)
- H R Dong
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - J J Yu
- School of Information Science and Engineering, Fudan University, Biomedical Engineering Center, Shanghai 200438, China
| | - X Y Chen
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - K L Xu
- School of Information Science and Engineering, Fudan University, Biomedical Engineering Center, Shanghai 200438, China
| | - R Xie
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai 200040, China
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6
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Jadhav AP. Vascular Myelopathies. Continuum (Minneap Minn) 2024; 30:160-179. [PMID: 38330477 DOI: 10.1212/con.0000000000001378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
OBJECTIVE Vascular injuries of the spinal cord are less common than those involving the brain; however, they can be equally devastating. This article discusses the diagnosis and management of ischemic and hemorrhagic vascular disorders of the spinal cord. LATEST DEVELOPMENTS Clinical suspicion remains the mainstay for recognizing vascular myelopathies, yet diagnoses are often delayed and challenging in part because of their rarity and atypical manifestations. Noninvasive imaging such as CT and MRI continues to improve in spatial resolution and diagnostic precision; however, catheter-based spinal angiography remains the gold standard for defining the spinal angioarchitecture. In addition to hemorrhagic and ischemic disease, the contribution of venous dysfunction is increasingly appreciated and informs treatment strategies in conditions such as intracranial hypotension. ESSENTIAL POINTS Vascular disorders of the spine manifest in variable and often atypical ways, which may lead to delayed diagnosis. Increased awareness of these conditions is critical for early recognition and treatment. The goal of treatment is to minimize long-term morbidity and mortality.
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Pardo CA. Clinical Approach to Myelopathy Diagnosis. Continuum (Minneap Minn) 2024; 30:14-52. [PMID: 38330471 DOI: 10.1212/con.0000000000001390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
OBJECTIVE This article describes an integrative strategy to evaluate patients with suspected myelopathy, provides advice on diagnostic approach, and outlines the framework for the etiologic diagnosis of myelopathies. LATEST DEVELOPMENTS Advances in diagnostic neuroimaging techniques of the spinal cord and improved understanding of the immune pathogenic mechanisms associated with spinal cord disorders have expanded the knowledge of inflammatory and noninflammatory myelopathies. The discovery of biomarkers of disease, such as anti-aquaporin 4 and anti-myelin oligodendrocyte glycoprotein antibodies involved in myelitis and other immune-related mechanisms, the emergence and identification of infectious disorders that target the spinal cord, and better recognition of myelopathies associated with vascular pathologies have expanded our knowledge about the broad clinical spectrum of myelopathies. ESSENTIAL POINTS Myelopathies include a group of inflammatory and noninflammatory disorders of the spinal cord that exhibit a wide variety of motor, sensory, gait, and sensory disturbances and produce major neurologic disability. Both inflammatory and noninflammatory myelopathies comprise a broad spectrum of pathophysiologic mechanisms and etiologic factors that lead to specific clinical features and presentations. Knowledge of the clinical variety of myelopathies and understanding of strategies for the precise diagnosis, identification of etiologic factors, and implementation of therapies can help improve outcomes.
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Grigoriadis S, Georgiadi E, Sidiropoulos TA, Efthimiou E, Spiliopoulos S. Spinal Cord Ischemia after Lumbar Artery Embolization for Retroperitoneal Hemorrhage. J Vasc Interv Radiol 2024; 35:329-330. [PMID: 38272641 DOI: 10.1016/j.jvir.2023.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/02/2023] [Accepted: 10/14/2023] [Indexed: 01/27/2024] Open
Affiliation(s)
- Stavros Grigoriadis
- Interventional Radiology Unit, 2nd Department of Radiology, Medical School, National and Kapodistrian University of Athens, "Attikon" University General Hospital, Athens, Greece.
| | - Eleni Georgiadi
- Interventional Radiology Unit, 2nd Department of Radiology, Medical School, National and Kapodistrian University of Athens, "Attikon" University General Hospital, Athens, Greece
| | - Theodoros A Sidiropoulos
- 4th Department of Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Evgenia Efthimiou
- Interventional Radiology Unit, 2nd Department of Radiology, Medical School, National and Kapodistrian University of Athens, "Attikon" University General Hospital, Athens, Greece
| | - Stavros Spiliopoulos
- Interventional Radiology Unit, 2nd Department of Radiology, Medical School, National and Kapodistrian University of Athens, "Attikon" University General Hospital, Athens, Greece
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Xu W, Ren J, Ye M. Concomitant Thoracic Spinal Dural Arteriovenous Fistula and Spinal Cavernous Malformation. World Neurosurg 2024; 181:90-92. [PMID: 36627020 DOI: 10.1016/j.wneu.2023.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 01/03/2023] [Accepted: 01/04/2023] [Indexed: 01/08/2023]
Abstract
Both spinal dural arteriovenous fistula (SDAVF) and spinal cavernous malformation (SCM) are uncommon vascular malformations. To our knowledge, such a case of SDAVF concomitant with SCM has not been reported. We encountered a case of a 55-year-old man who had weakness and numbness in both lower extremities. Magnetic resonance imaging showed a round-shape lesion identified as a cavernous malformation in the middle segment of the thoracic spine, with spinal edema and obvious flow voids. Diagnostic angiography revealed an SDAVF fed by the right T7 radicular artery with venous drainage. The intramedullary venous hypertension due to fistula was suspected of inducing the formation of SCM. This case may provide new insight into the pathogenesis of SCM.
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Affiliation(s)
- Wenlong Xu
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; China International Neuroscience Institute, Beijing, China
| | - Jian Ren
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; China International Neuroscience Institute, Beijing, China
| | - Ming Ye
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; China International Neuroscience Institute, Beijing, China.
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Kam J, Toomey F, Tan D, Castle-Kirszbaum M, Gauden A, Taniguchi S, Slater LA, Lai L. Microsurgical disconnection of a T12/L1 ventral intradural perimedullary arteriovenous fistula (type IV) via instrumented trans-pedicular approach. J Clin Neurosci 2023; 118:79-80. [PMID: 37890197 DOI: 10.1016/j.jocn.2023.09.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 09/19/2023] [Indexed: 10/29/2023]
Abstract
CASE DESCRIPTION We present a case of microsurgical disconnection of a PMAVF supplied by the artery of Adamkiewicz with fistulation at the ventral spinal cord.
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Affiliation(s)
- Jeremy Kam
- Department of Neurosurgery, Monash Medical Centre, Melbourne, Victoria, Australia; Department of Neurosurgery, Royal Melbourne Hospital, Melbourne, Victoria, Australia; Division of Neurosurgery , University of British Columbia, Vancouver, British Columbia, Canada.
| | - Fidel Toomey
- Department of Neurosurgery, Monash Medical Centre, Melbourne, Victoria, Australia
| | - Darius Tan
- Department of Neurosurgery, Monash Medical Centre, Melbourne, Victoria, Australia
| | | | - Andrew Gauden
- Department of Neurosurgery, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Seika Taniguchi
- Division of Neurosurgery , University of British Columbia, Vancouver, British Columbia, Canada
| | - Lee-Anne Slater
- Department of Radiology, Monash Medical Centre, Melbourne, Victoria, Australia
| | - Leon Lai
- Department of Neurosurgery, Monash Medical Centre, Melbourne, Victoria, Australia
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Öymen EM, Hansen HC, Hacker J, Jansen O. [Acute Anterior Spinal Artery Syndrome due to Fibrocartilaginous Embolism]. ROFO-FORTSCHR RONTG 2023; 195:1130-1134. [PMID: 37224870 DOI: 10.1055/a-2061-6626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Eren Melih Öymen
- Radiology/Neuroradiology, University Hospital Schleswig-Holstein Campus Kiel Clinic for Radiology and Neuroradiology, Kiel, Germany
| | | | - Johannes Hacker
- Neurology, Friedrich-Ebert-Hospital Neumünster, Neumunster, Germany
| | - Olav Jansen
- Radiology/Neuroradiology, University Hospital Schleswig-Holstein Campus Kiel Clinic for Radiology and Neuroradiology, Kiel, Germany
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12
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Peng Y, Ren Y, Hou J, Zhang C, He M, Huang B, Chen T, Li J. Clinical outcomes and prognostic factors in the surgical treatment of spinal dural arteriovenous fistulas: a retrospective study of 118 patients. Sci Rep 2023; 13:18266. [PMID: 37880297 PMCID: PMC10600191 DOI: 10.1038/s41598-023-45599-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 10/21/2023] [Indexed: 10/27/2023] Open
Abstract
Spinal dural arteriovenous fistulas (SDAVFs) are the most common type of spinal vascular malformations (AVMs), constituting approximately 70% of all spinal AVMs. The impact of various clinical and radiologic features on the outcomes in patients with SDAVFs is still controversial. The purpose of the study is to investigate the clinical outcomes and prognostic factors in patients with surgically treated SDAVFs in a single center. A retrospective review was performed for all patients with SDAVFs from January 2013 to September 2021 who underwent surgery at our institution. Medical records and pre- and postoperative imaging data were analyzed. Neurological function status was evaluated by modified Aminoff-Logue Scale (mALS). Student's t-test, Wilcoxon rank sum test, χ2 test and logistic regression were used to find significant prognostic factors. P values < 0.05 were considered significant. One hundred and eighteen patients were ultimately included in the study. By comparing preoperative and postoperative mALS, 69 (58.5%) patients experienced improvement, and 49 (41.5%) patients showed no improvement (worse or unchanged). Wilcoxon rank sum test showed that there was a difference between the improvement group and the no improvement group in preoperative mALS Micturition score and preoperative mALS Defecation score. The logistic regression revealed that preoperative mALS Gait score was associated with clinical improvement after surgery in patients with SDAVFs. Surgical treatment of SDAVFs is a safe and effective procedure and can lead to symptom improvement or stabilization in most patients. Preoperative neurological function status was the only factor associated with clinical prognosis.
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Affiliation(s)
- Youheng Peng
- Department of Neurosurgery, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, People's Republic of China
| | - Yanming Ren
- Department of Neurosurgery, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, People's Republic of China
| | - Jiguang Hou
- Department of Neurosurgery, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, People's Republic of China
| | - Changwei Zhang
- Department of Neurosurgery, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, People's Republic of China
| | - Min He
- Department of Neurosurgery, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, People's Republic of China
| | - Bowen Huang
- Department of Neurosurgery, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, People's Republic of China
| | - Tengyun Chen
- Department of Neurosurgery, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, People's Republic of China
| | - Jin Li
- Department of Neurosurgery, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, People's Republic of China.
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13
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Amabile A, Lewis E, Costa V, Tadros RO, Han DK, Di Luozzo G. Spinal cord protection in open and endovascular approaches to thoracoabdominal aortic aneurysms. Vascular 2023; 31:874-883. [PMID: 35507464 DOI: 10.1177/17085381221094411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Despite advancements in surgical and postoperative management, spinal cord injury has been a persistent complication of both open and endovascular repair of thoracoabdominal and descending thoracic aortic aneurysm. Spinal cord injury can be explained with an ischemia-infarction model which results in local edema of the spinal cord, damaging its structure and leading to reversible or irreversible loss of its function. Perfusion of the spinal cord during aortic procedures can be enhanced by several adjuncts which have been described with a broad variety of evidence in their support. These adjuncts include systemic hypothermia, cerebrospinal fluid drainage, extracorporeal circulation and distal aortic perfusion, segmental arteries reimplantation, left subclavian artery revascularization, and staged aortic repair. The Authors here reviewed and discussed the role of such adjuncts in preventing spinal cord injury from occurring, pinpointing current evidence and outlining future perspectives.
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Affiliation(s)
- Andrea Amabile
- Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Erin Lewis
- Department of Surgery, Rutgers-New Jersey Medical School, Newark, NJ, USA
| | - Victor Costa
- Department of Surgery, Rutgers-New Jersey Medical School, Newark, NJ, USA
| | - Rami O Tadros
- Division of Vascular Surgery, Department of Surgery, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Daniel K Han
- Division of Vascular Surgery, Department of Surgery, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Gabriele Di Luozzo
- Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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14
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Duarte Armindo R, Vilela P. What the Musculoskeletal Radiologist Needs to Know About the Vascular Anatomy of the Spine and Spinal Cord. Semin Musculoskelet Radiol 2023; 27:580-587. [PMID: 37816366 DOI: 10.1055/s-0043-1772171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/12/2023]
Abstract
This article describes the vascular anatomy of the spine and spinal cord, highlighting key structures and anatomical variations relevant to musculoskeletal radiologists. It covers the arterial and venous drainage systems, along with examples of vascular conditions affecting the spine. Understanding the vascular anatomy of the spine and spinal cord is crucial for accurate interpretation of imaging studies and safe spinal interventional procedures. Imaging techniques for evaluating vascular pathology of the spine are discussed and compared. Understanding vascular anatomy and the most common vascular disorders will lead to an accurate diagnosis and suggest the appropriate type of study needed for further characterization and/or patient management.
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Affiliation(s)
- Rui Duarte Armindo
- Neuroradiology Department, Western Lisbon University Hospital Centre (Centro Hospitalar Universitário Lisboa Ocidental), Lisbon, Portugal
- Neuroradiology Unit, Hospital da Luz Lisboa, Lisbon, Portugal
| | - Pedro Vilela
- Neuroradiology Department, Western Lisbon University Hospital Centre (Centro Hospitalar Universitário Lisboa Ocidental), Lisbon, Portugal
- Neuroradiology Unit, Hospital da Luz Lisboa, Lisbon, Portugal
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15
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Sharma A, Feng L, Muresanu DF, Tian ZR, Lafuente JV, Buzoianu AD, Nozari A, Wiklund L, Sharma HS. Spinal cord injury induced exacerbation of Alzheimer's disease like pathophysiology is reduced by topical application of nanowired cerebrolysin with monoclonal antibodies to amyloid beta peptide, p-tau and tumor necrosis factor alpha. Int Rev Neurobiol 2023; 172:3-35. [PMID: 37833015 DOI: 10.1016/bs.irn.2023.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/15/2023]
Abstract
Hallmark of Alzheimer's disease include amyloid beta peptide and phosphorylated tau deposition in brain that could be aggravated following traumatic of concussive head injury. However, amyloid beta peptide or p-tau in spinal cord following injury is not well known. In this investigation we measured amyloid beta peptide and p-tau together with tumor necrosis factor-alpha (TNF-α) in spinal cord and brain following 48 h after spinal cord injury in relation to the blood-spinal cord and blood-brain barrier, edema formation, blood flow changes and cell injury in perifocal regions of the spinal cord and brain areas. A focal spinal cord injury was inflicted over the right dorsal horn of the T10-11 segment (4 mm long and 2 mm deep) and amyloid beta peptide and p-tau was measured in perifocal rostral (T9) and caudal (T12) spinal cord segments as well as in the brain areas. Our observations showed a significant increase in amyloid beta peptide in the T9 and T12 segments as well as in remote areas of brain and spinal cord after 24 and 48 h injury. This is associated with breakdown of the blood-spinal cord (BSCB) and brain barriers (BBB), edema formation, reduction in blood flow and cell injury. After 48 h of spinal cord injury elevation of amyloid beta peptide, phosphorylated tau (p-tau) and tumor necrosis factor-alpha (TNF-α) was seen in T9 and T12 segments of spinal cord in cerebral cortex, hippocampus and brain stem regions associated with microglial activation as seen by upregulation of Iba1 and CD86. Repeated nanowired delivery of cerebrolysin topically over the traumatized segment repeatedly together with monoclonal antibodies (mAb) to amyloid beta peptide (AβP), p-tau and TNF-α significantly attenuated amyloid beta peptide, p-tau deposition and reduces Iba1, CD68 and TNF-α levels in the brain and spinal cord along with blockade of BBB and BSCB, reduction in blood flow, edema formation and cell injury. These observations are the first to show that spinal cord injury induces Alzheimer's disease like symptoms in the CNS, not reported earlier.
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Affiliation(s)
- Aruna Sharma
- International Experimental Central Nervous System Injury & Repair (IECNSIR), Dept. of Surgical Sciences, Anesthesiology & Intensive Care Medicine, Uppsala University Hospital, Uppsala University, Uppsala, Sweden.
| | - Lianyuan Feng
- Department of Neurology, Bethune International Peace Hospital, Zhongshan Road (West), Shijiazhuang, Hebei Province, P.R. China
| | - Dafin F Muresanu
- Dept. Clinical Neurosciences, University of Medicine & Pharmacy, Cluj-Napoca, Romania; ''RoNeuro'' Institute for Neurological Research and Diagnostic, Mircea Eliade Street, Cluj-Napoca, Romania
| | - Z Ryan Tian
- Dept. Chemistry & Biochemistry, University of Arkansas, Fayetteville, AR, United States
| | - José Vicente Lafuente
- LaNCE, Dept. Neuroscience, University of the Basque Country (UPV/EHU), Leioa, Bizkaia, Spain
| | - Anca D Buzoianu
- Department of Clinical Pharmacology and Toxicology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Ala Nozari
- Department of Anesthesiology, Boston University, Albany str, Boston MA, USA
| | - Lars Wiklund
- International Experimental Central Nervous System Injury & Repair (IECNSIR), Dept. of Surgical Sciences, Anesthesiology & Intensive Care Medicine, Uppsala University Hospital, Uppsala University, Uppsala, Sweden
| | - Hari Shanker Sharma
- International Experimental Central Nervous System Injury & Repair (IECNSIR), Dept. of Surgical Sciences, Anesthesiology & Intensive Care Medicine, Uppsala University Hospital, Uppsala University, Uppsala, Sweden; LaNCE, Dept. Neuroscience, University of the Basque Country (UPV/EHU), Leioa, Bizkaia, Spain
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16
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Shima S, Sato S, Ryu B, Kushi K, Mochizuki T, Inoue T, Okada Y, Niimi Y. Angiographic Index for the Treatment Efficacy and Functional Outcomes of Spinal Cord Arteriovenous Shunts: the Vertebral Blush Sign. Clin Neuroradiol 2023; 33:721-727. [PMID: 36856787 DOI: 10.1007/s00062-023-01266-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 01/18/2023] [Indexed: 03/02/2023]
Abstract
BACKGROUND The functional outcomes in spinal cord arteriovenous shunts (SCAVSs) are usually unpredictable from current assessments of treatment results. We aimed to investigate and propose a new index marker, the vertebral blush (VB) sign, for assessing the treatment efficacy of SCAVSs. METHODS This retrospective cohort study enrolled patients diagnosed with SCAVSs between June 2012 and May 2021. The VB sign was defined as the angiographic finding of reappearance or enhanced contrast staining of the vertebral bodies fed by shunt-related arteries observed after shunt occlusion. The primary outcome was the improvement in motor/sensory disturbances or sphincter impairments within 1 year after treatment. The secondary outcome was shunt recanalization. VB sign characteristics and associations with outcomes were analyzed. RESULTS Of 65 patients with SCAVSs, 57 were eligible for VB sign assessment; among these, there were 26 with the VB sign and 31 without the VB sign. Among vascular shunts perimedullary arteriovenous fistula showed the greatest difference in prevalence rate between those with and without the VB sign (33.3%, n = 9/27 versus 10.0%, n = 3/30; P = 0.031). On multivariable logistic regression analysis, SCAVSs with the VB sign had significantly more favorable outcomes than those without the VB sign (adjusted odds ratio, 5.61; 95% confidence interval, 1.48-21.23; P = 0.01). There was no relationship between the VB sign and secondary outcomes (P = 0.35). CONCLUSION The VB sign is independently associated with functional recovery after shunt occlusion and could be an assessment tool for the treatment efficacy of SCAVSs.
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Affiliation(s)
- Shogo Shima
- Department of Neuroendovascular Therapy, St. Luke's International Hospital, 9-1 Akashi-cho, 104-8560, Chuo-ku, Tokyo, Japan.
- Department of Neurosurgery, St. Luke's International Hospital, 9-1 Akashi-cho, 104-8560, Chuo-ku, Tokyo, Japan.
| | - Shinsuke Sato
- Department of Neuroendovascular Therapy, St. Luke's International Hospital, 9-1 Akashi-cho, 104-8560, Chuo-ku, Tokyo, Japan
- Department of Neurosurgery, St. Luke's International Hospital, 9-1 Akashi-cho, 104-8560, Chuo-ku, Tokyo, Japan
| | - Bikei Ryu
- Department of Neuroendovascular Therapy, St. Luke's International Hospital, 9-1 Akashi-cho, 104-8560, Chuo-ku, Tokyo, Japan
- Department of Neurosurgery, St. Luke's International Hospital, 9-1 Akashi-cho, 104-8560, Chuo-ku, Tokyo, Japan
| | - Kazuki Kushi
- Department of Neurosurgery, St. Luke's International Hospital, 9-1 Akashi-cho, 104-8560, Chuo-ku, Tokyo, Japan
| | - Tatsuki Mochizuki
- Department of Neuroendovascular Therapy, St. Luke's International Hospital, 9-1 Akashi-cho, 104-8560, Chuo-ku, Tokyo, Japan
- Department of Neurosurgery, St. Luke's International Hospital, 9-1 Akashi-cho, 104-8560, Chuo-ku, Tokyo, Japan
| | - Tatsuya Inoue
- Department of Neuroendovascular Therapy, St. Luke's International Hospital, 9-1 Akashi-cho, 104-8560, Chuo-ku, Tokyo, Japan
- Department of Neurosurgery, St. Luke's International Hospital, 9-1 Akashi-cho, 104-8560, Chuo-ku, Tokyo, Japan
| | - Yoshikazu Okada
- Department of Neurosurgery, St. Luke's International Hospital, 9-1 Akashi-cho, 104-8560, Chuo-ku, Tokyo, Japan
| | - Yasunari Niimi
- Department of Neuroendovascular Therapy, St. Luke's International Hospital, 9-1 Akashi-cho, 104-8560, Chuo-ku, Tokyo, Japan
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17
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Ishikawa H, Yamaguchi Y. Author's Response: Revisiting Spinal Cord Infarction after Bronchial Artery Embolization. J Vasc Interv Radiol 2023; 34:1618-1619. [PMID: 37315685 DOI: 10.1016/j.jvir.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 06/01/2023] [Indexed: 06/16/2023] Open
Affiliation(s)
- Hideo Ishikawa
- Hemoptysis and Pulmonary-Circulation Center, Eishinkai Kishiwada Rehabilitation Hospital, 2-8-10, Kamimatsu-cho, Kishiwada-City, Osaka 596-0827, Japan.
| | - Yu Yamaguchi
- Hemoptysis and Pulmonary-Circulation Center, Eishinkai Kishiwada Rehabilitation Hospital, 2-8-10, Kamimatsu-cho, Kishiwada-City, Osaka 596-0827, Japan
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18
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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19
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Alvernia JE, Simon E, Khandelwal K, Ramos CD, Perkins E, Kim P, Mertens P, Messina R, Luzardo G, Diaz O. Anatomical study of the thoracolumbar radiculomedullary arteries, including the Adamkiewicz artery and supporting radiculomedullary arteries. J Neurosurg Spine 2023; 38:233-241. [PMID: 36152330 DOI: 10.3171/2022.5.spine2214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 05/02/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The aim of this paper was to identify and characterize all the segmental radiculomedullary arteries (RMAs) that supply the thoracic and lumbar spinal cord. METHODS All RMAs from T4 to L5 were studied systematically in 25 cadaveric specimens. The RMA with the greatest diameter in each specimen was termed the artery of Adamkiewicz (AKA). Other supporting RMAs were also identified and characterized. RESULTS A total of 27 AKAs were found in 25 specimens. Twenty-two AKAs (81%) originated from a left thoracic or a left lumbar radicular branch, and 5 (19%) arose from the right. Two specimens (8%) had two AKAs each: one specimen with two AKAs on the left side and the other specimen with one AKA on each side. Eight cadaveric specimens (32%) had 10 additional RMAs; among those, a single additional RMA was found in 6 specimens (75%), and 2 additional RMAs were found in each of the remaining 2 specimens (25%). Of those specimens with a single additional RMA, the supporting RMA was ipsilateral to the AKA in 5 specimens (83%) and contralateral in only 1 specimen (17%). The specimens containing 2 additional RMAs were all (100%) ipsilateral to their respective AKAs. CONCLUSIONS The segmental RMAs supplying the thoracic and lumbar spinal cord can be unilateral, bilateral, or multiple. Multiple AKAs or additional RMAs supplying a single anterior spinal artery are common and should be considered when dealing with the spinal cord at the thoracolumbar level.
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Affiliation(s)
- Jorge E Alvernia
- 1Department of Neurosurgery, University of Mississippi, Jackson, Mississippi
- 2Brain and Spine Associates, Monroe, Louisiana
| | - Emile Simon
- 3Department of Neurosurgery, Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Bron, France
- 4Laboratory of Anatomy, Faculty of Medicine Lyon Est, Claude Bernard University Lyon 1, Lyon, France
| | | | - Cara D Ramos
- 1Department of Neurosurgery, University of Mississippi, Jackson, Mississippi
| | - Eddie Perkins
- 1Department of Neurosurgery, University of Mississippi, Jackson, Mississippi
| | - Patrick Kim
- 1Department of Neurosurgery, University of Mississippi, Jackson, Mississippi
| | - Patrick Mertens
- 3Department of Neurosurgery, Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Bron, France
- 4Laboratory of Anatomy, Faculty of Medicine Lyon Est, Claude Bernard University Lyon 1, Lyon, France
| | - Raffaella Messina
- 5Division of Neurosurgery University "Aldo Moro" of Bari, Italy; and
| | - Gustavo Luzardo
- 1Department of Neurosurgery, University of Mississippi, Jackson, Mississippi
| | - Orlando Diaz
- 6Department of Neurosurgery, Houston Methodist Hospital, Houston, Texas
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20
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Small JE, Pérez Pérez VH. The Dominant Anterior Thoracic Artery of the Spinal Cord. AJNR Am J Neuroradiol 2023; 44:111-114. [PMID: 36581455 PMCID: PMC9835921 DOI: 10.3174/ajnr.a7737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 10/25/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND PURPOSE Dominant radiculomedullary arteries such as the artery of lumbar enlargement and the artery of cervical enlargement are well-documented. However, variability exists as to the size, number, and location of other radiculomedullary arteries contributing supply to the anterior spinal artery. The aim of this anatomic study was to document the prevalence and characteristics of the dominant anterior thoracic artery in cadaveric specimens. MATERIALS AND METHODS Microsurgical dissection of cadaveric human spinal cord specimens (n = 50) was conducted. The artery of lumbar enlargement was injected with colored latex until the small-caliber arterial vessels were filled. The dominant anterior thoracic artery was identified, injected, and filled with diluted industrial paint. The course, diameter, and location of the dominant anterior thoracic artery, artery of lumbar enlargement, and artery of cervical enlargement were documented. RESULTS The artery of lumbar enlargement was identified between T3 and L2 in all 50 specimens (100%), and the artery of cervical enlargement was identified in 84% of specimens (42/50). At least 1 dominant anterior thoracic artery distinct from the artery of lumbar enlargement and the artery of cervical enlargement was identified between T1 and T11 in 47 of the 50 specimens (94%). The most frequent origin of the dominant anterior thoracic artery was at the level of T4 on the left. The average size of the dominant anterior thoracic artery was 0.446 mm (range, 0.300-0.759 mm on the left and 0.270-0.569 mm on the right). CONCLUSIONS A dominant anterior thoracic artery is present in 94% of individuals. Variations of the arterial supply to the anterior thoracic cord are of great importance due to their implications for ischemic events as well as surgical and endovascular procedures.
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Affiliation(s)
- J E Small
- From Lahey Hospital and Medical Center (J.E.S.), Burlington, Massachusetts
| | - V H Pérez Pérez
- Instituto de Ciencias Forenses (V.H.P.P), TSJ Ciudad de México, Centro Medico Siglo XXI, Mexico City, Mexico
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21
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Chou D, Narsinh K. Editorial. The relevance of the artery of Adamkiewicz in the 21st century. J Neurosurg Spine 2022; 38:230-231. [PMID: 36152328 DOI: 10.3171/2022.6.spine22532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Dean Chou
- 1Department of Neurosurgery, Columbia University Irving Medical Center, New York, New York; and
| | - Kazim Narsinh
- 2Department of Radiology, University of California, San Francisco, California
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22
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Honkanen HP, Mustonen C, Herajärvi J, Tuominen H, Starck T, Kallio M, Kiviluoma K, Anttila V, Juvonen T. Priming protects the spinal cord in an experimental aortic occlusion model. J Thorac Cardiovasc Surg 2022; 164:801-809.e2. [PMID: 33220965 DOI: 10.1016/j.jtcvs.2020.09.137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 09/23/2020] [Accepted: 09/28/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Paraplegia is a devastating complication in aortic aneurysm surgery. Modifying the spinal cord vasculature is a promising method in spinal cord protection. The aim of this study was to assess whether the spinal cord can be primed by occluding thoracic segmental arteries before simulated aneurysm repair in a porcine model. METHODS Twelve piglets were randomly assigned to the priming group (6) and the control group (6). Eight uppermost thoracic segmental arteries were occluded at 5-minute intervals in the priming group before a 25-minute aortic crossclamp. In the control group, the aorta was crossclamped for 25 minutes. During the first 5 minutes, 8 segmental arteries were occluded. After the aortic crossclamping, piglets were observed under anesthesia for 5 hours and followed up 5 days postoperatively. Near-infrared spectroscopy, motor-evoked potentials, blood samples, neurology with the modified Tarlov score, and histopathology of the spinal cord were assessed. RESULTS The median Tarlov score during the first postoperative day was higher in the priming group than in the control group (P = .001). At the end, 50% of the control animals had paraplegia compared with 0% of paraplegia in the priming group. The mean regional histopathologic score differed between the priming group and the control group (P = .02). The priming group had higher motor-evoked potentials during the operation at separate time points. The lactate levels were lower in the priming group compared with the control group (Pg = .001, Pg×t = .18). CONCLUSIONS Acute priming protects the spinal cord from ischemic injury in an experimental aortic crossclamp model.
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Affiliation(s)
- Hannu-Pekka Honkanen
- Research Unit of Surgery, Anesthesia and Intensive Care, University of Oulu, Medical Research Center, Oulu, Finland.
| | - Caius Mustonen
- Research Unit of Surgery, Anesthesia and Intensive Care, University of Oulu, Medical Research Center, Oulu, Finland
| | - Johanna Herajärvi
- Research Unit of Surgery, Anesthesia and Intensive Care, University of Oulu, Medical Research Center, Oulu, Finland; University Department of Cardiac Surgery, Heart Centre Leipzig, Leipzig, Germany
| | - Hannu Tuominen
- Department of Pathology, Oulu University Hospital, Oulu, Finland
| | - Tuomo Starck
- Research Unit of Medical Imaging, Physics and Technology, Medical Research Center Oulu University of Oulu, Oulu, Finland; Department of Clinical Neurophysiology, Oulu University Hospital, Oulu, Finland
| | - Mika Kallio
- Research Unit of Medical Imaging, Physics and Technology, Medical Research Center Oulu University of Oulu, Oulu, Finland; Department of Clinical Neurophysiology, Oulu University Hospital, Oulu, Finland
| | - Kai Kiviluoma
- Research Unit of Surgery, Anesthesia and Intensive Care, University of Oulu, Medical Research Center, Oulu, Finland
| | - Vesa Anttila
- Heart Center, University of Turku and Turku University Hospital, Turku, Finland
| | - Tatu Juvonen
- Research Unit of Surgery, Anesthesia and Intensive Care, University of Oulu, Medical Research Center, Oulu, Finland; Department of Cardiac Surgery, Heart and Lung Center, Helsinki University Central Hospital, Helsinki, Finland
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23
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Thron A, Stoeter P, Schiessl J, Prescher A. Development of the Arterial Supply of the Spinal Cord Tissue Based on Radioanatomical and Histological Studies in Cattle. Clin Neuroradiol 2022; 32:325-343. [PMID: 34581828 PMCID: PMC9187566 DOI: 10.1007/s00062-021-01093-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 07/19/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Angiographic techniques have gained increasing importance in suspected vascular disease of the spinal cord. This demands an advanced understanding of spinal cord blood vessel anatomy and its embryologically founded broad spectrum of variations. The aim of this study was to improve knowledge on contentious issues concerning the development of spinal cord arterial supply in higher mammals and to offer visual information of high didactic value. METHODS The prenatal development was examined in cattle, using multiplanar high-resolution microangiography of injected specimens and microscopic sections. The gestational ages of the 15 specimens were between the late embryonic and the early fetal period (5-11 weeks). Microangiography of the human spinal cord from an earlier published study were used to envisage an adult arterial vascularization pattern in higher mammals. RESULTS Establishment of the unpaired anterior spinal artery (ASA) goes through two procedures of reconfiguration until achieving its final design. Regression of the primarily established anteromedian tract is observed in cattle fetuses of 9-10 weeks. Return to the ontogenetic disposition of bilateral symmetry and a burst of vascularization from all parts of the spinal meninges follow and include the anterior median fissure as a preferred vascular pathway. Large sulcal/central arteries longitudinally anastomosing between each other emerge on both sides of the midline. The embryological pattern of exclusive peripheral medullary supply must have been converted into a combined system of predominant central (centrifugal) supply of the enlargements before a final unpaired ASA can be reconstructed. CONCLUSION Previous investigators focused on the early embryonic development of spinal cord arteries and missed the profound remodeling of the vascular architecture in the early fetal period.
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Affiliation(s)
- Armin Thron
- Clinic for Diagnostic and Interventional Neuroradiology, University Hospital RWTH Aachen, Pauwelsstr. 30, 52057, Aachen, Germany.
- , Theaterstr. 31, 52062, Aachen, Germany.
| | - Peter Stoeter
- Department of Radiology, CEDIMAT, Plaza de la Salud, Santo Domingo, Dominican Republic
| | | | - Andreas Prescher
- Institute of Molecular and Cellular Anatomy, University Hospital RWTH Aachen, Prosektur, Wendlingweg 2, 52074, Aachen, Germany
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24
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Barrey CY, Baassiri W, Vandenbulcke A. Clipping Test of a Radiculomedullary Artery During Resection of a Dorsal Spinal Meningioma. World Neurosurg 2022; 164:159. [PMID: 35562039 DOI: 10.1016/j.wneu.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 05/01/2022] [Accepted: 05/02/2022] [Indexed: 11/19/2022]
Abstract
Arterial supply of the spinal cord is derived from the anterior spinal artery (ASA) and 2 posterior spinal arteries. In the thoracic spine, a few segmental arteries give origins to radiculomedullary arteries (RMAs) that supply the ASA and posterior spinal arteries.1 In the lower thoracic spine, the supply is provided by the Adamkiewicz artery. Spinal meningiomas may be embedded and/or supplied by the RMA, which may be sacrificed to obtain complete resection. Safety of the thoracic RMA occlusion is controversial,2 especially if the Adamkiewicz artery is involved.3 Somatosensory evoked potentials (SSEPs) and motor evoked potentials (MEP) are proposed to detect spinal cord ischemia.4 The RMA supplies the anterior spinal cord, and MEPs seem to be more sensitive than SSEPs to test RMA occlusion.2 SSEP and MEP monitoring during temporary occlusion has been described and significantly changes at 2 and 7 minutes of occlusion.5-8 Safe occlusion with unchanged MEPs after 10-minute temporary occlusion of 32 segmental arteries was reported by Salame et al.9 We intraoperatively discovered an anterior T10 RMA supplying the adjacent meningioma (Video 1). We temporary clipped the artery for 8 minutes. MEPs were recorded before clipping and every 2 minutes. No changes were observed, and the artery was sacrificed. RMA or segmental artery ligature may be required and is frequently performed in deformity, oncologic, and vascular spine surgery. The clipping test with MEP monitoring is a useful and simple intraoperative tool to identify the critical afferents of the ASA. It doesn't require planification or supplementary materials. Further study might be performed to validate the technique.
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Affiliation(s)
- Cédric Y Barrey
- Department of Spine Surgery, Pierre Wertheimer Hospital, Hospice Civils, Lyon, France
| | - Wassim Baassiri
- Department of Spine Surgery, Pierre Wertheimer Hospital, Hospice Civils, Lyon, France
| | - Alberto Vandenbulcke
- Department of Spine Surgery, Pierre Wertheimer Hospital, Hospice Civils, Lyon, France.
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MacGillivray TE, Gleason TG, Patel HJ, Aldea GS, Bavaria JE, Beaver TM, Chen EP, Czerny M, Estrera AL, Firestone S, Fischbein MP, Hughes GC, Hui DS, Kissoon K, Lawton JS, Pacini D, Reece TB, Roselli EE, Stulak J. The Society of Thoracic Surgeons/American Association for Thoracic Surgery clinical practice guidelines on the management of type B aortic dissection. J Thorac Cardiovasc Surg 2022; 163:1231-1249. [PMID: 35090765 DOI: 10.1016/j.jtcvs.2021.11.091] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 11/08/2021] [Indexed: 01/16/2023]
Affiliation(s)
| | - Thomas G Gleason
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Md
| | - Himanshu J Patel
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
| | - Gabriel S Aldea
- Division of Cardiothoracic Surgery, University of Washington School of Medicine, Seattle, Wash
| | - Joseph E Bavaria
- Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pa
| | - Thomas M Beaver
- Division of Thoracic and Cardiovascular Surgery, University of Florida, Gainesville, Fla
| | - Edward P Chen
- Division of Cardiovascular and Thoracic Surgery, Duke University School of Medicine, Durham, NC
| | - Martin Czerny
- Department of Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany
| | - Anthony L Estrera
- Department of Cardiothoracic and Vascular Surgery, The University of Texas Health Science Center at Houston and Memorial Hermann Hospital, Houston, Tex
| | | | - Michael P Fischbein
- Department of Cardiothoracic Surgery, Stanford University, School of Medicine, Stanford, Calif
| | - G Chad Hughes
- Division of Cardiovascular and Thoracic Surgery, Duke University School of Medicine, Durham, NC
| | - Dawn S Hui
- Department of Cardiothoracic Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Tex
| | | | - Jennifer S Lawton
- Division of Cardiac Surgery, Johns Hopkins University, Baltimore, Md
| | - Davide Pacini
- Department of Cardiac Surgery, University of Bologna, Bologna, Italy
| | - T Brett Reece
- Department of Cardiothoracic Surgery, University of Colorado School of Medicine, Aurora, Colo
| | - Eric E Roselli
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - John Stulak
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn
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Honkanen HP, Mustonen C, Tuominen H, Kiviluoma K, Anttila V, Juvonen T. Spinal cord injury during selective cerebral perfusion and segmental artery occlusion: an experimental study. Interact Cardiovasc Thorac Surg 2022; 34:145-152. [PMID: 34999799 PMCID: PMC8923407 DOI: 10.1093/icvts/ivab219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 06/14/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Since selective cerebral perfusion (SCP) has been used in aortic arch surgical procedures, the core temperature during lower body circulatory arrest (LBCA) has been steadily rising. Simultaneously, the use of a frozen elephant trunk (FET) graft has been increasing. The safe period of LBCA in relation to spinal cord ischaemic tolerance in combination with segmental artery occlusion by the FET procedure has not been defined. METHODS Sixteen pigs were assigned to undergo 65 (n = 10) or 90 min (n = 6) of SCP at 28°C with LBCA in combination with occlusion of the 8 uppermost segmental arteries in the thoracic (Th) aorta (15-20 cm FET, Th8-level). The follow-up period consisted of a 6-h intensive period and a 5-day observation period. Near-infrared spectroscopy of the collateral network was used to determine spinal cord oxygenation. The neurological status of the patients was evaluated daily, and the brain and the spinal cord were harvested for a histopathological analysis. RESULTS Five out of 6 pigs after 90 min and 1 out of 10 pigs after 65 min of LBCA died within 48 h of multiorgan failure. Of the survivors in the 65-min group, 6 out of 9 had paraparesis/paraplegia; the remaining 3 reached normal function. The lone survivor after 90 min of LBCA was paraplegic. Nadir near-infrared spectroscopy of the collateral network values at Th8 and Th10 were 34 (±5) and 39 (±4), and they were reached within 35 min of SCP in both groups. CONCLUSIONS An extended FET graft with LBCA and SCP durations >65 min at 28°C results in a poor outcome.
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Affiliation(s)
- Hannu-Pekka Honkanen
- Department of Surgery, Research Unit of Surgery, Anaesthesia and Intensive Care, University of Oulu, Medical Research Center, Oulu, Finland
| | - Caius Mustonen
- Department of Surgery, Research Unit of Surgery, Anaesthesia and Intensive Care, University of Oulu, Medical Research Center, Oulu, Finland
| | - Hannu Tuominen
- Department of Pathology, Oulu University Hospital, Oulu, Finland
| | - Kai Kiviluoma
- Department of Surgery, Research Unit of Surgery, Anaesthesia and Intensive Care, University of Oulu, Medical Research Center, Oulu, Finland
| | - Vesa Anttila
- Department of Surgery, Heart Center, University of Turku and Turku University Hospital, Turku, Finland
| | - Tatu Juvonen
- Department of Surgery, Research Unit of Surgery, Anaesthesia and Intensive Care, University of Oulu, Medical Research Center, Oulu, Finland
- Department of Cardiac Surgery, Heart and Lung Center, Helsinki University Central Hospital, Helsinki, Finland
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27
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Das KK, Nangarwal B, Gosal JS, Bhaisora KS, Srinivasan R, Srivastava AK. Microneurosurgery for Spinal Dural Arteriovenous Fistula- Operative Video. Neurol India 2022; 70:54-56. [PMID: 35263853 DOI: 10.4103/0028-3886.338640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND AND INTRODUCTION Spinal dural arteriovenous fistula (SDAVF) is a rare but curable condition. Microsurgery is a highly effective and readily affordable treatment modality. OBJECTIVE We present a surgical video of SDAVF to demonstrate the operative nuances involved. SURGICAL TECHNIQUE A 53-year-old wheelchair-bound man with spastic paraparesis for 1.5 years was found to have a SDAVF at L1/2 level with a single fistula point. During surgery, a L1-L2 laminectomy and durotomy revealed a dilated vein accompanying the nerve root exiting L1/2 foramen that showed early filling on indocyanine green (ICG) video angiography. This vein was occluded, and a segment of this vein was removed during surgery, which led to resumption of normal spinal cord perfusion. RESULTS The patient showed gradual recovery of lower limb motor power and improved to assisted ambulation after 3 months. CONCLUSIONS Surgery is a simple, effective, and cost-effective treatment option in SDAVF.
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Affiliation(s)
- Kuntal K Das
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Bhawan Nangarwal
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Jaskaran S Gosal
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Kamlesh S Bhaisora
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Rahul Srinivasan
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Arun K Srivastava
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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28
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Simon MV, Dong CC, Jacobs MJ, Mess WH. Neuromonitoring during descending aorta procedures. Handb Clin Neurol 2022; 186:407-431. [PMID: 35772899 DOI: 10.1016/b978-0-12-819826-1.00010-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Thoraco-abdominal aneurysm (TAA) repair carries a significant risk of spinal cord infarction. The latter results from irreversible changes in the spinal cord arterial network, e.g., sacrifice of the segmental arteries. Intra-operative neurophysiology with somatosensory and especially motor evoked potential (SEP and MEP respectively) monitoring, has emerged as an effective tool to assess the efficiency of the collateral blood flow, detect reversible spinal cord ischemia and guide the peri-operative multidisciplinary management to prevent postoperative paraplegia. The main roles of such monitoring include diagnosis of spinal cord vs peripheral limb ischemia, titration of mean arterial pressure during aortic clamping, the guidance of selective re-implantation of critical segmental arteries, and management of hemodynamics in the immediate postoperative period. In addition, manipulation of the aortic arch and proximal descending aorta, adds the risk of cerebral infarction from both low flow state and/or thromboembolic events. As such, EEG monitoring may be a useful add-on for either assessment of the efficiency of cerebral cooling as a neuroprotective method and/or for detection and treatment of reversible cerebral ischemia. This chapter presents the multimodality approach to open TAA monitoring as a versatile tool for the prevention of devastating postoperative neurologic deficits.
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Affiliation(s)
- Mirela V Simon
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States.
| | - Charles C Dong
- Department of Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Michael J Jacobs
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Werner H Mess
- Department of Clinical Neurophysiology, Maastricht University Medical Center, Maastricht, The Netherlands
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29
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Awad H, Efanov A, Rajan J, Denney A, Gigax B, Kobalka P, Kelani H, Basso DM, Bozinovski J, Tili E. Histological Findings After Aortic Cross-Clamping in Preclinical Animal Models. J Neuropathol Exp Neurol 2021; 80:895-911. [PMID: 34534333 PMCID: PMC8783616 DOI: 10.1093/jnen/nlab084] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Spinal cord ischemic injury and paralysis are devastating complications after open surgical repair of thoracoabdominal aortic aneurysms. Preclinical models have been developed to simulate the clinical paradigm to better understand the neuropathophysiology and develop therapeutic treatment. Neuropathological findings in the preclinical models have not been comprehensively examined before. This systematic review studies the past 40 years of the histological findings after open surgical repair in preclinical models. Our main finding is that damage is predominantly in the grey matter of the spinal cord, although white matter damage in the spinal cord is also reported. Future research needs to examine the neuropathological findings in preclinical models after endovascular repair, a newer type of surgical repair used to treat aortic aneurysms.
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Affiliation(s)
- Hamdy Awad
- From the Department of Anesthesiology, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
| | - Alexander Efanov
- From the Department of Anesthesiology, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
| | - Jayanth Rajan
- From the Department of Anesthesiology, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
| | - Andrew Denney
- From the Department of Anesthesiology, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
| | - Bradley Gigax
- From the Department of Anesthesiology, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
| | - Peter Kobalka
- Department of Pathology, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
| | - Hesham Kelani
- From the Department of Anesthesiology, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
| | - D Michele Basso
- Department of Neuroscience, School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio, USA
| | - John Bozinovski
- Division of Cardiac Surgery, Department of Surgery, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
| | - Esmerina Tili
- From the Department of Anesthesiology, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
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30
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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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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32
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Caplan LR, Chang YM. Severe Unilateral Proprioceptive Loss in Medullary- Rostral Spinal Cord Infarction. A Posterior Spinal Artery Syndrome. J Stroke Cerebrovasc Dis 2021; 30:105882. [PMID: 34077822 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105882] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 05/07/2021] [Accepted: 05/07/2021] [Indexed: 11/17/2022] Open
Abstract
We draw attention to a unique presentation, severe unilateral loss of limb proprioception, in patients with medullary and rostral spinal cord infarction. Two patients developed acute severe proprioceptive loss in the limbs ipsilateral to infarcts that involved the caudal medulla and rostral spinal cord. They also had symptoms and signs often found in lateral medullary infarction. The proprioceptive loss is attributable to injury to the gracile and cuneate nuclei and/or their projections to the medial lemniscus. The infarct territory is supplied by the posterior spinal branches of the vertebral artery near its penetration into the posterior fossa. The presence of severe ipsilateral proprioceptive loss in a patient with features of lateral medullary infarction indicates involvement of the rostral spinal cord.
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Affiliation(s)
- Louis R Caplan
- Beth Israel Deaconess Medical center, 330 Brookline Ave, Boston, MA 02215, USA.
| | - Yu-Ming Chang
- Beth Israel Deaconess Medical Center, Department of Radiology, 330 Brookline Avenue, Boston, MA 02215-5400, USA
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33
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Grace-Farfaglia P. Self-Reported Diet and Health Outcomes of Participants of the CCSVI-Tracking Survey Study. Nutrients 2021; 13:nu13061891. [PMID: 34072860 PMCID: PMC8230225 DOI: 10.3390/nu13061891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 05/24/2021] [Accepted: 05/27/2021] [Indexed: 11/16/2022] Open
Abstract
Of the 1575 participants of the CCSVI-Tracking Survey, 475 patients recorded their quality of life and EDSS outcomes for at least 2 months. Self-reported use of complementary and conventional therapies included diet, use of drug therapy, symptoms, quality of life, and mobility. Analysis included comparing outcomes related to different diets within and between groups. Adherence to the MS diet was not associated with a greater quality of life, less disability, a lower Symptom Score, or faster walking speed compared to other diets. Alternately, the participants from the Mediterranean diet region as a whole (µ = 32.65 (SD = 11.37, SEM = 2.37, p = 0.05) had a significantly greater QoL (µ = 60, p = 0.05) and a lower MS symptom score, µ = 32.65 (11.37), p = 0.0029. A decline of symptoms was observed in all diet groups over 3 months with the most dramatic decline observed in participants from the Eastern Mediterranean diet region. The main effect for the within-subjects factor was significant, F(3, 1056) = 55.95, p < 0.001, indicating that there were significant differences between the groups.
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Affiliation(s)
- Patricia Grace-Farfaglia
- Department of Health Science, Rocky Mountain University of Health Professions, Provo, UT 84606, USA;
- Department of Health Science, College of Health Professions, Sacred Heart University, Fairfield, CT 06825, USA
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Abstract
Functional magnetic resonance imaging (fMRI) of the spinal cord relies on the integrity of neurovascular coupling (NVC) to infer neuronal activity from hemodynamic changes. Astrocytes are a key component of cerebral NVC, but their role in spinal NVC is unclear. The objective of this study was to examine whether inhibition of astrocyte metabolism by fluorocitrate alters spinal NVC. In 14 rats, local field potential (LFP) and spinal cord blood flow (SCBF) were recorded simultaneously in the lumbosacral enlargement during noxious stimulation of the sciatic nerve before and after a local administration of fluorocitrate (N = 7) or saline (N = 7). Fluorocitrate significantly reduced SCBF responses (p < 0.001) but not LFP amplitude (p = 0.22) compared with saline. Accordingly, NVC was altered by fluorocitrate compared with saline (p < 0.01). These results support the role of astrocytes in spinal NVC and have implications for spinal cord imaging with fMRI for conditions in which astrocyte metabolism may be altered.
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Affiliation(s)
- Thierry Paquette
- Department of Anatomy, Université du Québec À Trois-Rivières, 3351 Boulevard des Forges, C.P. 500, Trois-Rivières, QC, G9A 5H7, Canada
- CogNAC Research Group, Université du Québec À Trois-Rivières, Trois-Rivières, QC, G9A 5H7, Canada
| | - Mathieu Piché
- Department of Anatomy, Université du Québec À Trois-Rivières, 3351 Boulevard des Forges, C.P. 500, Trois-Rivières, QC, G9A 5H7, Canada
- CogNAC Research Group, Université du Québec À Trois-Rivières, Trois-Rivières, QC, G9A 5H7, Canada
| | - Hugues Leblond
- Department of Anatomy, Université du Québec À Trois-Rivières, 3351 Boulevard des Forges, C.P. 500, Trois-Rivières, QC, G9A 5H7, Canada.
- CogNAC Research Group, Université du Québec À Trois-Rivières, Trois-Rivières, QC, G9A 5H7, Canada.
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35
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Busch DR, Lin W, Goh CC, Gao F, Larson N, Wahl J, Bilfinger TV, Yodh AG, Floyd TF. Towards rapid intraoperative axial localization of spinal cord ischemia with epidural diffuse correlation monitoring. PLoS One 2021; 16:e0251271. [PMID: 33970932 PMCID: PMC8109798 DOI: 10.1371/journal.pone.0251271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 04/23/2021] [Indexed: 11/19/2022] Open
Abstract
Spinal cord ischemia leads to iatrogenic injury in multiple surgical fields, and the ability to immediately identify onset and anatomic origin of ischemia is critical to its management. Current clinical monitoring, however, does not directly measure spinal cord blood flow, resulting in poor sensitivity/specificity, delayed alerts, and delayed intervention. We have developed an epidural device employing diffuse correlation spectroscopy (DCS) to monitor spinal cord ischemia continuously at multiple positions. We investigate the ability of this device to localize spinal cord ischemia in a porcine model and validate DCS versus Laser Doppler Flowmetry (LDF). Specifically, we demonstrate continuous (>0.1Hz) spatially resolved (3 locations) monitoring of spinal cord blood flow in a purely ischemic model with an epidural DCS probe. Changes in blood flow measured by DCS and LDF were highly correlated (r = 0.83). Spinal cord blood flow measured by DCS caudal to aortic occlusion decreased 62%. This monitor demonstrated a sensitivity of 0.87 and specificity of 0.91 for detection of a 25% decrease in flow. This technology may enable early identification and critically important localization of spinal cord ischemia.
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Affiliation(s)
- David R. Busch
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
- Neurology, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
| | - Wei Lin
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, New York, United States of America
| | - Chia Chieh Goh
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, New York, United States of America
| | - Feng Gao
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
| | - Nicholas Larson
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
| | - Joseph Wahl
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
| | - Thomas V. Bilfinger
- Department of Surgery, Stony Brook University, Stony Brook, New York, United States of America
| | - Arjun G. Yodh
- Department of Physics and Astronomy, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Thomas F. Floyd
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
- Department of Cardiothoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
- * E-mail:
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36
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Tenorio A, Holmes BB, Abla AA, Amans M, Meisel K. An isolated ruptured spinal aneurysm presents with a thalamic Infarct: case report. BMC Neurol 2021; 21:52. [PMID: 33535981 PMCID: PMC7856767 DOI: 10.1186/s12883-021-02055-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 01/12/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Isolated spinal artery aneurysms are extremely rare, and their pathogenesis, clinical presentation, and treatment strategies are poorly established. We report only the second case of a patient with an isolated posterior spinal aneurysm and concurrent left thalamic infarct and review the literature to help clarify treatment strategies of isolated spinal aneurysms. CASE PRESENTATION A 49-year-old patient presented with acute onset walking difficulty followed by diaphoresis, back and abdominal pain, and paraplegia. Imaging was notable for a hemorrhagic spinal lesion with compression at T12 through L4 and an acute left thalamic infarct. Surgical exploration revealed an isolated posterior spinal artery aneurysm. The aneurysm was surgically resected and the patient had partial recovery six months post-operatively. CONCLUSIONS Isolated posterior spinal artery aneurysms of the thoracolumbar region are rare lesions that commonly present with abdominal pain, radiating back pain, and lower extremity weakness. Imaging may not provide a definitive diagnosis. The three primary treatment strategies are conservative management, endovascular treatment, or surgical resection. In patients with symptomatic cord compression, immediate surgical intervention is indicated to preserve neurologic function. In all other cases, the artery size, distal flow, morphology, and location may guide management.
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Affiliation(s)
- Alexander Tenorio
- Department of Neurology, University of California, San Francisco, CA, USA.
| | - Brandon B Holmes
- Department of Neurology, University of California, San Francisco, CA, USA
| | - Adib A Abla
- Department of Neurosurgery, University of California, San Francisco, CA, USA
| | - Matthew Amans
- Department of Neurointerventional Radiology, University of California, San Francisco, CA, USA
| | - Karl Meisel
- Department of Neurology, University of California, San Francisco, CA, USA
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Shetty GS, Singh V, Prasad SN, Phadke RV, Neyaz Z, Udiya A, Behari S. Spinal Epidural Fistulas-A Separate Entity to Dural Fistulas with Different Angioarchitecture and Treatment Approach. World Neurosurg 2021; 149:e600-e611. [PMID: 33548535 DOI: 10.1016/j.wneu.2021.01.126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 01/24/2021] [Accepted: 01/25/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Spinal epidural arteriovenous fistulas (SEAVFs) are the rarest variety of spinal vascular malformation and are often misdiagnosed as type 1 spinal dural fistula. This retrospective study highlights the salient anatomic differentiating points of these entities and also highlights the importance of a planned endovascular treatment approach using different routes of access. Efficacy of the endovascular treatment at 3 months follow-up was also studied. METHODS We retrospectively reviewed 11 treated patients with SEAVF. Existence of epidural arteriovenous fistula in all these patients was confirmed by spinal angiography. The Aminoff-Logue Scale score was assigned both before and after the procedure. The statistical results were expressed as percentages, and the preprocedure scale was compared with the postprocedure scale at 3 months by using a nonparametric Wilcoxon signed-rank test. RESULTS The patients ranged in age from 7 to 53 years, with male predominance. Paraparesis was the commonest symptom, and 1 patient had congestive cardiac failure caused by a large fistula. Location was mostly dorsolumbar with intradural venous reflux into the perimedullary venous system (Castilla type A) noted in 3/11(27%) patients, and the remaining 73% patients had Castilla type B1 with an enlarged epidural venous sac. Therapeutic embolization was performed from arterial, venous, or combined routes. The 3-month postprocedure clinical assessment showed statistically significant (P < 0.004) improvement in the Aminoff-Logue Scale score. CONCLUSIONS The differentiating points between SEAVF compared with type 1 spinal dural fistula are emphasized. The study also highlights the importance of a good angiographic assessment to best access the fistula by arterial, venous, percutaneous, or combined routes. Endovascular treatment resulted in statistically significant clinical improvement at 3 months follow-up.
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Affiliation(s)
| | - Vivek Singh
- Department of Radiodiagnosis (Neuroradiology Section), Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.
| | - Surya Nandan Prasad
- Department of Radiodiagnosis (Neuroradiology Section), Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Rajendra V Phadke
- Department of Radiodiagnosis (Neuroradiology Section), Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Zafar Neyaz
- Department of Radiodiagnosis (Neuroradiology Section), Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | | | - Sanjay Behari
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
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Ying X, Xie Q, Yu X, Li S, Wu Q, Chen X, Yue J, Zhou K, Tu W, Jiang S. Water treadmill training protects the integrity of the blood-spinal cord barrier following SCI via the BDNF/TrkB-CREB signalling pathway. Neurochem Int 2021; 143:104945. [PMID: 33359781 DOI: 10.1016/j.neuint.2020.104945] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 12/17/2020] [Accepted: 12/20/2020] [Indexed: 12/18/2022]
Abstract
Following spinal cord injury (SCI), destruction of the blood-spinal cord barrier (BSCB) leads to increased microvascular permeability and tissue oedema. The BSCB, formed by a dense network of tight junctions (TJs) and adhesion junctions (AJs) is considered a therapeutic target. Most studies have focused on the effect of drug therapy on the neurovascular system after SCI, ignoring the protection and functional recovery of the vascular system by exercise training. Previously, we indicated that water treadmill training (TT) has a protective effect on the BSCB after SCI, but the specific molecular mechanism of the effect of TT on BSCB is still not clear. In this study, we used a specific inhibitor of TrkB (ANA-12) to explore whether the BDNF/TrkB-CREB signalling pathway is involved in TT-mediated BSCB protection after SCI. A New York University (NYU) impactor was used to establish the SCI model. Rats in the SI (Sham + ANA-12), IM (SCI + ANA-12) and ITM (SCI + TT + ANA-12) groups were injected with ANA-12 (0.5 mg/kg) daily, and rats in TM (SCI + TT) and ITM (SCI + TT + ANA-12) groups were treated with water TT for 7 or 14 d. The degree of neurological deficit, water content, BSCB permeability, protein expression and ultrastructure of vascular endothelial cells were assessed by the Basso-Beattie-Bresnahan (BBB) motor rating scale, Evans blue (EB), Western blot (WB) experiments, immunofluorescence and transmission electron microscopy (TEM). Our results suggest that TT upregulates the BDNF/TrkB-CREB signalling pathway following SCI. The BDNF/TrkB-CREB signalling pathway is involved in the protection of the BSCB. Application of the inhibitor blocked the protective effect of TT on the BSCB. We concluded that TT ameliorated SCI-induced BSCB impairment by upregulating the BDNF/TrkB-CREB signalling pathways.
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Affiliation(s)
- Xinwang Ying
- Department of Physical Medicine and Rehabilitation, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang Province, China
| | - Qingfeng Xie
- Department of Physical Medicine and Rehabilitation, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang Province, China
| | - Xiaolan Yu
- Department of Physical Medicine and Rehabilitation, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang Province, China
| | - Shengcun Li
- Department of Physical Medicine and Rehabilitation, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang Province, China
| | - Qiaoyun Wu
- Department of Physical Medicine and Rehabilitation, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang Province, China
| | - Xiaolong Chen
- Department of Physical Medicine and Rehabilitation, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang Province, China
| | - Jingjing Yue
- Department of Physical Medicine and Rehabilitation, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang Province, China
| | - Kecheng Zhou
- Department of Physical Medicine and Rehabilitation, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang Province, China
| | - Wenzhan Tu
- Department of Physical Medicine and Rehabilitation, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang Province, China
| | - Songhe Jiang
- Department of Physical Medicine and Rehabilitation, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang Province, China; Department of Intelligent Rehabilitation International (cross-strait) Alliance of Wenzhou Medical University, Wenzhou, 325000, Zhejiang Province, China.
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Bruce M, Hannah A, Hammond R, Khaing ZZ, Tremblay-Darveau C, Burns PN, Hofstetter CP. High-Frequency Nonlinear Doppler Contrast-Enhanced Ultrasound Imaging of Blood Flow. IEEE Trans Ultrason Ferroelectr Freq Control 2020; 67:1776-1784. [PMID: 32275589 DOI: 10.1109/tuffc.2020.2986486] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Current methods for in vivo microvascular imaging (<1 mm) are limited by the tradeoffs between the depth of penetration, resolution, and acquisition time. Ultrasound Doppler approaches combined at elevated frequencies (<7.5 MHz) are able to visualize smaller vasculature and, however, are still limited in the segmentation of lower velocity blood flow from moving tissue. Contrast-enhanced ultrasound (CEUS) has been successful in visualizing changes in microvascular flow at conventional diagnostic ultrasound imaging frequencies (<7.5 MHz). However, conventional CEUS approaches at elevated frequencies have met with limited success, due, in part, to the diminishing microbubble response with frequency. We apply a plane-wave acquisition combined with the non-linear Doppler processing of ultrasound contrast agents at 15 MHz to improve the resolution of microvascular blood flow while compensating for reduced microbubble response. This plane-wave Doppler approach of imaging ultrasound contrast agents also enables simultaneous detection and separation of blood flow in the microcirculation and higher velocity flow in the larger vasculature. We apply singular value decomposition filtering on the nonlinear Doppler signal to orthogonally separate the more stationary lower velocity flow in the microcirculation and higher velocity flow in the larger vasculature. This orthogonal separation was also utilized to improve time-intensity curve analysis of the microcirculation, by removing higher velocity flow corrupting bolus kinetics. We demonstrate the utility of this imaging approach in a rat spinal cord injury model, requiring submillimeter resolution.
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Li T, Zhao Z, Wang Y, Xie J, Zhang Y, Bi N, Shi Z, Lu Q, Li Q. A preliminary study of spinal cord blood flow during PVCR with spinal column shortening: A prospective clinic study in severe rigid scoliokyphosis patients. Medicine (Baltimore) 2020; 99:e21579. [PMID: 32769906 PMCID: PMC7593061 DOI: 10.1097/md.0000000000021579] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Posterior vertebral column resection (PVCR) was the most powerful technique for treating severe rigid spinal deformity, but it has been plagued with high neurologic deficits risk. The fluctuations of spinal cord blood flow (SCBF) play an important role in secondary spinal cord injury during deformity correction surgery.The objective of this study was to first provide the characteristic of SCBF during PVCR with spinal column shortening in severe rigid spinal deformity.Severe rigid scoliokyphosis patients received PVCR above L1 level were included in this prospective study. Patients with simple kyphosis, intraspinal pathology and any degree of neurologic deficits were excluded. The deformity correction was based on spinal column shortening over the resected gap during PVCR. Laser Doppler flowmetry was used to monitor the SCBF at different surgical stages.There were 12 severe rigid scoliokyphosis patients in the study. The baseline SCBF was 316 ± 86 perfusion unite (PU), and the SCBF decreased to 228 ± 68 PU after VCR (P = .008). The SCBF increased to 296 ± 102 PU after the middle shortening and correction which has a 121% increased comparison to the SCBF after VCR (P = .02). The SCBF will slightly decrease to 271 ± 65 PU at final fixation. The postoperative neural physical examination of all patients was negative, and the MEP and SSEP of all patients did not reach the alarm value during surgery.These results indicate that PVCR is accompanied by a change in SCBF, a proper spinal cord shortening can protect the SCBF and can prevent a secondary spinal cord injury during the surgery.
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Hino T, Kamitani T, Sagiyama K, Yamasaki Y, Matsuura Y, Tsutsui S, Sakai Y, Furuyama T, Yabuuchi H. Detectability of the artery of Adamkiewicz on computed tomography angiography of the aorta by using ultra-high-resolution computed tomography. Jpn J Radiol 2020; 38:658-665. [PMID: 32170567 DOI: 10.1007/s11604-020-00943-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 03/02/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the detectability of AKA on aortic computed tomography angiography (CTA) using ultra-high-resolution computed tomography (UHRCT). MATERIALS AND METHODS Twenty-eight patients were enrolled. They underwent aortic CTA with UHRCT (UHRCTA) and had previously undergone aortic conventional CTA (CCTA). The injection protocol of UHRCTA was the same as that of CCTA. The bolus tracking technique was used. UHRCTA images were reconstructed with adaptive iterative dose reduction (strong) and with forward-projected model-based iterative reconstruction solution. The matrix size and slice thickness on UHRCT were 1024 and 0.25 mm, respectively, and those on conventional CT were 512 and 0.5 or 0.67 mm, respectively. The UHRCTA and CCTA images were visually compared by using four scales. A score of 4 or 3 indicated that the AKA was assessable. In this instance, the contrast-to-noise ratios of each UHRCTA were measured. The exposure dose and signal-to-noise ratios were also investigated. RESULTS The AKA visualization scores obtained with UHRCTA with forward-projected model-based iterative reconstruction solution were significantly higher than those with adaptive iterative dose reduction (p = 0.018) and CCTA (p = 0.0024). CONCLUSION UHRCT can contribute to the better visualization of the AKA on aortic CTA.
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Affiliation(s)
- Takuya Hino
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Takeshi Kamitani
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Koji Sagiyama
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Yuzo Yamasaki
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Yuko Matsuura
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Soichiro Tsutsui
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Yuki Sakai
- Division of Radiology, Department of Medical Technology, Kyushu University Hospital, Fukuoka, Japan
| | - Tadashi Furuyama
- Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hidetake Yabuuchi
- Health Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Takahashi K, Matsumoto Y, Nagata Y, Hashikawa T, Sakai H, Furuta K, Yoshitake H, Nakagawa S, Fukushima Y. The Shunt Point of the Sacral Dural Arteriovenous Fistula: A Case Report and Literature Review. World Neurosurg 2020; 143:518-526. [PMID: 32068174 DOI: 10.1016/j.wneu.2020.02.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 02/05/2020] [Accepted: 02/06/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND The occurrence of sacral dural arteriovenous fistula (dAVF) is rare. The detailed vascular architecture of sacral dAVF, including 3-dimensional (3D) angiographic images with operative findings, has not been evaluated compared with that of the thoracic and lumbar levels. We report a case of sacral dAVF with 3D angiographic examination and operative findings, with a literature review. CASE DESCRIPTION A 60-year-old man presented with progressive urinary incontinence and gait disturbance. A sacral dAVF was detected at the S1-2 level. The shunt point was at the medial side of the line between the intermediate sacral crest and the most medial point of the L5 pedicle circle at the anterior posterior view of the angiography; we defined this type as the medial type. After embolization, latent inflow arteries were visualized ipsilaterally and contralaterally. During surgery, because of dAVF recurrence, a vascular tangle was found on the dura. The surgical interruption of the draining vein improved the patient's symptoms. From the literature review, 92% of cases had medial-type shunt point. It is possible for sacral dAVF to have multiple inflow arteries originating ipsilaterally or bilaterally, and a venous pouch. CONCLUSIONS The shunt point of sacral dAVF tended to be located medially, not in the sacral foramen. Sacral dAVF has unique angioarchitecture. The differentiation of dAVF from epidural arteriovenous fistula may not be easy in some cases of sacral lesions. Therefore, further studies with a larger number of patients focused on the detailed vascular architecture are needed.
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Affiliation(s)
- Kenji Takahashi
- Department of Neurosurgery, St. Mary's Hospital, Fukuoka, Japan
| | | | - Yui Nagata
- Department of Neurosurgery, St. Mary's Hospital, Fukuoka, Japan
| | | | - Hideki Sakai
- Department of Neurosurgery, St. Mary's Hospital, Fukuoka, Japan
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Montague-Cardoso K, Pitcher T, Chisolm K, Salera G, Lindstrom E, Hewitt E, Solito E, Malcangio M. Changes in vascular permeability in the spinal cord contribute to chemotherapy-induced neuropathic pain. Brain Behav Immun 2020; 83:248-259. [PMID: 31669344 PMCID: PMC6928576 DOI: 10.1016/j.bbi.2019.10.018] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 10/18/2019] [Accepted: 10/23/2019] [Indexed: 01/10/2023] Open
Abstract
Chemotherapy-induced neuropathic pain is a dose-limiting side effect of many cancer therapies due to their propensity to accumulate in peripheral nerves, which is facilitated by the permeability of the blood-nerve barrier. Preclinically, the chemotherapy agent vincristine (VCR) activates endothelial cells in the murine peripheral nervous system and in doing so allows the infiltration of monocytes into nerve tissue where they orchestrate the development of VCR-induced nociceptive hypersensitivity. In this study we demonstrate that VCR also activates endothelial cells in the murine central nervous system, increases paracellular permeability and decreases trans endothelial resistance. In in vivo imaging studies in mice, VCR administration results in trafficking of inflammatory monocytes through the endothelium. Indeed, VCR treatment affects the integrity of the blood-spinal cord-barrier as indicated by Evans Blue extravasation, disrupts tight junction coupling and is accompanied by the presence of monocytes in the spinal cord. Such inflammatory monocytes (Iba-1+ CCR2+ Ly6C+ TMEM119- cells) that infiltrate the spinal cord also express the pro-nociceptive cysteine protease Cathepsin S. Systemic treatment with a CNS-penetrant, but not a peripherally-restricted, inhibitor of Cathepsin S prevents the development of VCR-induced hypersensitivity, suggesting that infiltrating monocytes play a functional role in sensitising spinal cord nociceptive neurons. Our findings guide us towards a better understanding of central mechanisms of pain associated with VCR treatment and thus pave the way for the development of innovative antinociceptive strategies.
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Affiliation(s)
- Karli Montague-Cardoso
- Wolfson Centre for Age-related Diseases, Guy's Hospital Campus, King's College London, London SE1 1UL, United Kingdom.
| | - Thomas Pitcher
- Wolfson Centre for Age-related Diseases, Guy's Hospital Campus, King's College London, London SE1 1UL, United Kingdom
| | - Kim Chisolm
- Wolfson Centre for Age-related Diseases, Guy's Hospital Campus, King's College London, London SE1 1UL, United Kingdom
| | - Giorgia Salera
- William Harvey Research Institute, Bart's and The London School of Medicine Queen Mary, Charterhouse Square, London EC1M 6BQ, United Kingdom
| | | | | | - Egle Solito
- William Harvey Research Institute, Bart's and The London School of Medicine Queen Mary, Charterhouse Square, London EC1M 6BQ, United Kingdom
| | - Marzia Malcangio
- Wolfson Centre for Age-related Diseases, Guy's Hospital Campus, King's College London, London SE1 1UL, United Kingdom.
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Perez Perez VH, Hernesniemi J, Small JE. Anatomy of the Great Posterior Radiculomedullary Artery. AJNR Am J Neuroradiol 2019; 40:2010-2015. [PMID: 31753838 PMCID: PMC6975349 DOI: 10.3174/ajnr.a6304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 09/19/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Although considerable variability exists as to the overall caliber of radiculomedullary arteries, dominant radiculomedullary arteries such as the artery of Adamkiewicz exist. The existence of a great posterior radiculomedullary artery has attracted little attention and has been a matter of debate. The aim of this anatomic study was to determine the presence or absence of the great posterior radiculomedullary artery. MATERIALS AND METHODS We performed microsurgical dissection on formaldehyde-fixed cadaveric human spinal cords. The artery of Adamkiewicz in the spinal cord specimens (n = 50) was injected with colored latex until the small-caliber arterial vessels were filled and the great posterior radiculomedullary artery was identified. The course, diameter, and location of great posterior radiculomedullary artery were documented. RESULTS A great posterior radiculomedullary artery was identified in 36 (72%) spinal cord specimens. In 11 (22%) specimens, bilateral great posterior radiculomedullary arteries were present. In 13 cases (26%), a unilateral left-sided great posterior radiculomedullary artery was identified. In 11 cases (22%), a unilateral right-sided great posterior radiculomedullary artery was identified. In 1 specimen (2%), 3 right-sided great posterior radiculomedullary arteries were noted. The average size of the great posterior radiculomedullary arteries was 0.44 mm (range, 0.120-0.678 mm on the left and 0.260-0.635 mm on the right). CONCLUSIONS A great posterior radiculomedullary artery is present in most (72%) individuals. The authors describe the microsurgical anatomy of the great posterior radiculomedullary artery with emphasis on its morphometric parameters as well as its implications for spinal cord blood supply. Variations of the arterial supply to the dorsal cord are of great importance due to their implications for ischemic events, endovascular procedures, and surgical approaches.
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Affiliation(s)
- V H Perez Perez
- From the Department of Neurosurgery (V.H.P.P.), Instituto de Ciencias Forenses, TSJ Ciudad de México, Centro Medico Siglo XXI, Mexico City, Mexico
| | - J Hernesniemi
- Department of Neurosurgery (H.J.), International Center for Neurosurgery, Henan Provincial People's Hospital, Zhengzhou, China
| | - J E Small
- Department of Radiology (J.E.S.), Neuroradiology Section, Lahey Hospital and Medical Center, Burlington, Massachusetts.
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Yin R, Zhu Y, Su Z, Chang P, Zhu Q, Gu R, Xing H, Zhao B, An Y, Yang F, Zhang BY. Catastrophic thoracolumbar spinal massive hematoma triggered by intraspinal anesthesia puncture: A CARE-compliant case report. Medicine (Baltimore) 2019; 98:e17553. [PMID: 31593138 PMCID: PMC6799862 DOI: 10.1097/md.0000000000017553] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Intraspinal anesthesia, the most common anesthesia type of orthopedic operation, is regarded as safe and simple. Despite of the rare incidence, puncture related complication of intraspinal anesthesia is catastrophic for spinal cord. Here we present an intradural hematoma case triggered by improper anesthesia puncture. The principal reason of this tragedy was rooted in the neglect of spine deformities diagnosis before anesthesia. To the best of our knowledge, there is no specific case report focusing on the intradural hematoma triggered by improper anesthesia puncture. PATIENT CONCERNS Hereby a case of thoracolumbar spinal massive hematoma triggered by intraspinal anesthesia puncture was reported. The presenting complaint of the patient was little neurologic function improvement after surgery at 6-month follow-up. DIAGNOSES Emergency MRI demonstrated that massive spindle-like intradural T2-weighted image hypointense signal masses from T12 to S2 badly compressed the dural sac ventrally, and his conus medullaris was at L3/4 intervertebral level with absence of L5 vertebral lamina. Hereby, the diagnoses were congenital spinal bifida, tethered cord syndrome, spine intradural hematoma, and paraplegia. INTERVENTIONS Urgent surgical interventions including laminectomy, spinal canal exploration hematoma removal, and pedicle fixation were performed. The patient received both medication (mannitol, mecobalamin, and steroids) and rehabilitation (neuromuscular electric stimulation, hyperbaric oxygen). OUTCOMES Postoperation, he had regained only hip and knee flexion at II grade strength. His neurologic function was unchanged until 3 weeks postoperation. Six-month follow-up showed just little neurologic function improvement, and the American Spinal Injury Association grade was C. LESSONS By presenting an intradural hematoma case triggered by improper anesthesia puncture, we shared the treatment experience and discussed the potential mechanism of neurologic compromise. The principal reason for this tragedy is preanesthesia examination deficiency. Necessary radiology examinations must be performed to prevent misdiagnosis for spinal malformation.
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Affiliation(s)
| | | | - Zhenbo Su
- Anesthesia Department, China-Japan Union Hospital of Jilin University
| | - Pengyu Chang
- Radiotherapy Department, First Bethune Hospital of Jilin University
| | | | - Rui Gu
- Orthopaedics Surgery Department
| | | | | | - Yuan An
- Hepatobiliary Department, China-Japan Union Hospital of Jilin University
| | - Fuwei Yang
- Neurosurgery Department, China-Japan Union Hospital of Jilin University, Changchun, Jilin Province, China
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Abstract
PURPOSE OF REVIEW Prompt recognition and timely management of vascular disorders of the spinal cord can improve patient outcomes. This article provides contemporary and practical knowledge about the most common vascular myelopathies. RECENT FINDINGS New studies have provided additional information on the risk factors and impact of neurologic monitoring on perioperative spinal cord infarction. Additionally, recent publications have provided information on the impact of misdiagnosis, corticosteroid treatment, and postoperative prognosis in the treatment of spinal dural arteriovenous fistulas and have discussed the outcome of patients with spinal arteriovenous malformations treated with embolization, surgery, and stereotactic radiosurgery. Finally, recent studies have provided information on the natural history and postoperative prognosis of spinal cavernous malformations and on the risk factors and surgical outcome of patients with spinal epidural hematomas. SUMMARY Diagnostic and therapeutic challenges are inherent in managing patients with vascular disorders of the spinal cord, and clinicians should have a thorough understanding of these disorders to facilitate optimal outcomes for patients with these potentially devastating illnesses. This article begins by reviewing functional vascular anatomy and subsequently describes the fundamental characteristics of both ischemic and hemorrhagic vascular myelopathies to equip clinicians with the knowledge to avoid common pitfalls.
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Taterra D, Skinningsrud B, Pękala PA, Hsieh WC, Cirocchi R, Walocha JA, Tubbs RS, Tomaszewski KA, Henry BM. Artery of Adamkiewicz: a meta-analysis of anatomical characteristics. Neuroradiology 2019; 61:869-880. [PMID: 31030251 PMCID: PMC6620248 DOI: 10.1007/s00234-019-02207-y] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 04/01/2019] [Indexed: 12/03/2022]
Abstract
PURPOSE The artery of Adamkiewicz (AKA) provides the major blood supply to the anterior thoracolumbar spinal cord and iatrogenic injury or inadequate reconstruction of this vessel during vascular and endovascular surgery can result in postoperative neurological deficit due to spinal cord ischemia. The aim of this study was to provide comprehensive data on the prevalence and anatomical characteristics of the AKA. METHODS An extensive search was conducted through the major electronic databases to identify eligible articles. Data extracted included study type, prevalence of the AKA, gender, number of AKA per patient, laterality, origin based on vertebral level, side of origin, morphometric data, and ethnicity subgroups. RESULTS A total of 60 studies (n = 5437 subjects) were included in the meta-analysis. Our main findings revealed that the AKA was present in 84.6% of the population, and patients most frequently had a single AKA (87.4%) on the left side (76.6%) originating between T8 and L1 (89%). CONCLUSION As an AKA is present in the majority of the population, caution should be taken during vascular and endovascular surgical procedures to avoid injury or ensure proper reconstruction. All surgeons operating in the thoracolumbar spinal cord should have a thorough understanding of the anatomical characteristics and surgical implications of an AKA.
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Affiliation(s)
- Dominik Taterra
- International Evidence-Based Anatomy Working Group, Kraków, Poland
- Department of Anatomy, Jagiellonian University Medical College, 12 Kopernika Street, 31-034, Kraków, Poland
| | - Bendik Skinningsrud
- International Evidence-Based Anatomy Working Group, Kraków, Poland
- Department of Anatomy, Jagiellonian University Medical College, 12 Kopernika Street, 31-034, Kraków, Poland
| | - Przemysław A Pękala
- International Evidence-Based Anatomy Working Group, Kraków, Poland
- Department of Anatomy, Jagiellonian University Medical College, 12 Kopernika Street, 31-034, Kraków, Poland
| | - Wan Chin Hsieh
- International Evidence-Based Anatomy Working Group, Kraków, Poland
- First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Roberto Cirocchi
- Department of Surgical Sciences, Radiology and Dentistry, University of Perugia, Perugia, Italy
| | - Jerzy A Walocha
- International Evidence-Based Anatomy Working Group, Kraków, Poland
- Department of Anatomy, Jagiellonian University Medical College, 12 Kopernika Street, 31-034, Kraków, Poland
| | | | - Krzysztof A Tomaszewski
- International Evidence-Based Anatomy Working Group, Kraków, Poland.
- Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski KrakowUniversity, Kraków, Poland.
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Shin JH, Choi Y, Park B, Shin NY, Jang J, Choi HS, Jung SL, Ahn K, Kim BS. Diagnostic accuracy and efficiency of combined acquisition of low-dose time-resolved and single-phase high-resolution contrast-enhanced magnetic resonance angiography in a single session for pre-angiographic evaluation of spinal vascular disease. PLoS One 2019; 14:e0214289. [PMID: 30921365 PMCID: PMC6438605 DOI: 10.1371/journal.pone.0214289] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 03/11/2019] [Indexed: 12/03/2022] Open
Abstract
Background/Purpose The purpose of this study was to evaluate the utility and efficacy of combined low-dose, time-resolved (TR) and single-phase high-resolution (HR) contrast-enhanced MRA (CE-MRA) as a pre-angiographic study for spinal vascular disease. Materials and methods Seventeen consecutive patients with suspected spinal vascular disease were retrospectively reviewed. All patients underwent combined low-dose TR CE-MRA and three-dimensional single-phase HR CE-MRA at 3 Tesla, followed by conventional spinal digital subtraction angiography (DSA) within 90 days. Six patients underwent additional spinal MRA and DSA for treatment follow-up. Spinal lesions were analyzed in terms of presence, disease type, laterality, spinal level, and number of arterial feeders. Results Low-dose TR CE-MRA helped proper localization of subsequent HR CE-MRA in two patients with high or low level of the lesion. For initial detection of spinal vascular disease, sensitivity, specificity and accuracy of CE-MRA were 93.3% (n = 14/15), 100% (n = 3/3), and 94.4% (n = 17/18), respectively. In characterization of dural arteriovenous fistula (AVF), perimedullary AVF, spinal cord arteriovenous malformation (AVM), and extraspinal AVM, CE-MRA correctly characterized in 86.7% (n = 13/15) among the positive findings, and in 88.9% (n = 16/18) among the several patients including negative results. CE-MRA showed matched per-case localization of arterial feeders within 1 vertebral level in 80% (n = 12/15), and matched per-lesion localization in 78.3% (n = 18/23). Conclusion Combined low-dose TR CE-MRA and single-phase HR CE-MRA at 3 Tesla was an effective and accurate non-invasive tool for the pre-angiographic evaluation of spinal vascular diseases in a single session.
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Affiliation(s)
- Jae Ho Shin
- Department of Radiology, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Yangsean Choi
- Department of Radiology, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Borim Park
- Department of Radiology, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Na-Young Shin
- Department of Radiology, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Jinhee Jang
- Department of Radiology, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Hyun Seok Choi
- Department of Radiology, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - So Lyung Jung
- Department of Radiology, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Kookjin Ahn
- Department of Radiology, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Bum-soo Kim
- Department of Radiology, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
- * E-mail:
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