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Zhang K, Li C, Hou K, Yu J. Role of the Cervical Anterior Spinal Artery in the Endovascular Treatment of Vascular Diseases: Bystander, Accomplice, Victim, or Friend? Front Neurol 2021; 12:761006. [PMID: 34764934 PMCID: PMC8576071 DOI: 10.3389/fneur.2021.761006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 09/22/2021] [Indexed: 11/13/2022] Open
Abstract
The cervical anterior spinal artery (ASA) is a very important artery arising from the intracranial vertebral artery (VA). It can play different roles in endovascular treatment (EVT) of spinal vascular diseases. The current understanding of these roles is incomplete; therefore, we performed this review. We found that cervical ASA can be involved in many spinal vascular diseases, such as arteriovenous fistula (AVF), arteriovenous malformation (AVM), and aneurysm, and can serve as a collateral channel in proximal VA occlusion. In AVF and AVM, when the cervical ASA is involved, it often plays the role of an accomplice or victim because it acts as the feeder or as a bystander that does not provide blood flow to the AVF and AVM. In cervical ASA aneurysm, the ASA is a victim. During EVT of VA aneurysms or stenoses, the cervical ASA ostia can be covered or occluded, resulting in ASA ischemia. In this situation, the ASA is a victim. In VA occlusion or the subclavian steal phenomenon, the cervical ASA can serve as a collateral channel to provide blood flow to the posterior circulation. In this case, the ASA plays the role of a friend. According to the role of the cervical ASA in spinal vascular diseases, EVT should be determined “case by case.” Most importantly, when EVT is performed to treat these diseases, the cervical ASA axis must be preserved. Therefore, understanding the role of the cervical ASA in spinal vascular diseases is crucial.
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Affiliation(s)
- Kun Zhang
- Department of Cerebrovascular Disease, Henan Provincial People's Hospital, Zhengzhou University, Zhengzhou, China
| | - Chao Li
- Department of Neurology, First Hospital of Jilin University, Changchun, China
| | - Kun Hou
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, China
| | - Jinlu Yu
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, China
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Condette-Auliac S, Gratieux J, Boulin A, Di Maria F, Consoli A, Coskun O, Smajda S, Rodesch G. Imaging of vascular diseases of the spinal cord. Rev Neurol (Paris) 2021; 177:477-489. [PMID: 33902944 DOI: 10.1016/j.neurol.2021.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 04/13/2021] [Indexed: 11/15/2022]
Affiliation(s)
- S Condette-Auliac
- Department of Diagnostic and Therapeutic Neuroradiology, Hôpital Foch, Suresnes, France.
| | - J Gratieux
- Department of Diagnostic and Therapeutic Neuroradiology, Hôpital Foch, Suresnes, France
| | - A Boulin
- Department of Diagnostic and Therapeutic Neuroradiology, Hôpital Foch, Suresnes, France
| | - F Di Maria
- Department of Diagnostic and Therapeutic Neuroradiology, Hôpital Foch, Suresnes, France
| | - A Consoli
- Department of Diagnostic and Therapeutic Neuroradiology, Hôpital Foch, Suresnes, France
| | - O Coskun
- Department of Diagnostic and Therapeutic Neuroradiology, Hôpital Foch, Suresnes, France
| | - S Smajda
- Department of interventional Neuroradiology, Fondation Rotschild, Paris, France
| | - G Rodesch
- Department of Diagnostic and Therapeutic Neuroradiology, Hôpital Foch, Suresnes, France
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Grossberg JA, Howard BM, Saindane AM. The use of contrast-enhanced, time-resolved magnetic resonance angiography in cerebrovascular pathology. Neurosurg Focus 2020; 47:E3. [PMID: 31786556 DOI: 10.3171/2019.9.focus19627] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 09/05/2019] [Indexed: 11/06/2022]
Abstract
Digital subtraction angiography (DSA) has long been the imaging gold standard in the evaluation, treatment, and follow-up of cerebro- and spinovascular disorders. However, DSA has the disadvantages of invasiveness, contrast allergy or nephropathy, the impracticality of procedural preparation and recovery, and expense. Contrast-enhanced (CE), time-resolved (TR) magnetic resonance angiography (CE TR-MRA) is a sophisticated, relatively novel imaging modality that provides multiphasic contrast-enhanced visualization of the neurovasculature. Given the crucial role of angiography in all aspects of care for patients with complex neurovascular disorders, it is incumbent on those who care for these patients to understand the usefulness and pitfalls of novel imaging in this arena to ensure best practices, and to deliver cutting edge care to these patients in a way that minimizes cost, but does not compromise quality. CE TR-MRA has the potential to play an expanded role in the workup and follow-up across the spectrum of neurovascular disease, and this review is aimed to help neurosurgeons better understand how CE TR-MRA can be used to better manage patients in this cohort.
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Affiliation(s)
| | - Brian M Howard
- Departments of1Neurosurgery and.,2Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Amit M Saindane
- 2Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
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Mull M, Othman A, Dafotakis M, Hans FJ, Schubert GA, Jablawi F. Spinal Epidural Arteriovenous Fistula with Perimedullary Venous Reflux: Clinical and Neuroradiologic Features of an Underestimated Vascular Disorder. AJNR Am J Neuroradiol 2018; 39:2095-2102. [PMID: 30337434 DOI: 10.3174/ajnr.a5854] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 08/13/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The purpose of this study was to discuss the clinical and radiologic characteristics of spinal epidural arteriovenous fistulas (SEAVF) and demonstrate their specific angiomorphology in a single-center series. MATERIALS AND METHODS Thirteen consecutive patients were diagnosed with SEAVF at RWTH Aachen University Hospital between 2006 and 2018 and were included in this study. All patients had MR imaging and DSA before treatment; 10 of these 13 patients received contrast-enhanced MRA (CE-MRA). RESULTS The mean patient age was 72 ± 8 years. Paraparesis was present in 12 (92%) patients. Sphincter dysfunction and sensory symptoms were observed in 7 (54%) and 6 (46%) patients, respectively. The mean duration of symptoms was 6 ± 8 months. Congestive myelopathy on MR imaging was present in all patients. Prominent arterialized perimedullary veins were demonstrated in only 3 cases. CE-MRA revealed arterialized perimedullary veins and an arterialized epidural pouch in 9/10 (90%) patients, mostly located ventrolaterally. DSA demonstrated a multisegmental extension of the arterialized ventrolateral epidural pouch in 6 (46%) cases. An intradural radicular drainage vein was localized distant from the original fistula point in 3 (23%) patients. CONCLUSIONS Congestive myelopathy with an acute/subacute clinical course was the dominant finding in spinal epidural arteriovenous fistulas. CE-MRA is a powerful diagnostic tool for identifying arterialized perimedullary veins as well as an arterialized epidural pouch. While arterialized perimedullary veins frequently present with only mild enlargement and elongation in spinal epidural arteriovenous fistulas, the arterialized epidural pouch is frequently located ventrolaterally and may extend over several vertebral levels. DSA remains the criterion standard to precisely visualize a spinal epidural arteriovenous fistula and its intradural radicular drainage vein, which may be located distant from the fistulous point.
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Affiliation(s)
- M Mull
- From the Departments of Diagnostic and Interventional Neuroradiology (M.M., A.O., F.J.)
| | - A Othman
- From the Departments of Diagnostic and Interventional Neuroradiology (M.M., A.O., F.J.).,Department of Diagnostic and Interventional Radiology (A.O.), University Hospital Tübingen, Tübingen, Germany
| | | | - F-J Hans
- Department of Neurosurgery (F.-J.H.), Paracelsus Kliniken, Osnabrück, Germany
| | - G A Schubert
- Neurosurgery (G.A.S.), University Hospital Aachen, RWTH Aachen University, Aachen, Germany
| | - F Jablawi
- From the Departments of Diagnostic and Interventional Neuroradiology (M.M., A.O., F.J.).,Department of Neurosurgery (F.J.), Justus-Liebig-University, Giessen, Giessen, Germany
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Brinjikji W, Hilditch CA, Morris JM, Dmytriw AA, Cloft H, Pereira VM, Lanzino G, Krings T. Dilated Vein of the Filum Terminale on MRI: A Marker for Deep Lumbar and Sacral Dural and Epidural Arteriovenous Fistulas. AJNR Am J Neuroradiol 2018; 39:1953-1956. [PMID: 30237303 DOI: 10.3174/ajnr.a5784] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 07/17/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Conventional MR imaging can provide important clues regarding the location of a spinal vascular malformation. We hypothesized that a dilated vein of the filum terminale, identified as a curvilinear flow void on T2WI, could be an imaging marker for a lower lumbar (L3-L5) or sacral fistula. MATERIALS AND METHODS We retrospectively identified all spinal dural and spinal epidural arteriovenous fistulas from 2 large tertiary referral centers from 2005 to 2018. All patients had a lumbar spinal MR imaging and a conventional spinal angiography. Images were reviewed by 2 neuroradiologists who categorized the level of the arterial feeder to the fistula and the presence or absence of a dilated vein of the filum terminale on T2WI and T1 postcontrast images. We calculated the sensitivity, specificity, positive predictive value, and negative predictive value of the presence of a dilated filum terminale vein for a deep lumbar or sacral fistula. RESULTS One hundred sixty-two patients were included. An enlarged filum terminale vein was identified in 39 patients. Sensitivity, specificity, positive predictive value, and negative predictive value of the presence of a dilated filum terminale vein for a deep lumbar or sacral fistula were 86%, 98.3%, 94.9%, and 95.1%, respectively. CONCLUSIONS The presence of a dilated vein of the filum terminale can accurately localize a spinal dural arteriovenous fistula/spinal epidural arteriovenous fistula to the lower lumbar or sacral spine in patients being evaluated for such lesions. This finding can be used to facilitate both noninvasive and conventional spinal angiography.
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Affiliation(s)
- W Brinjikji
- From the Departments of Radiology (W.B., J.M.M., H.C., G.L.) .,Neurosurgery (W.B., G.L.), Mayo Clinic, Rochester, Minnesota.,Joint Department of Medical Imaging (W.B., C.A.H., A.A.D., V.M.P., T.K.), Toronto Western Hospital, Toronto, Ontario, Canada
| | - C A Hilditch
- Joint Department of Medical Imaging (W.B., C.A.H., A.A.D., V.M.P., T.K.), Toronto Western Hospital, Toronto, Ontario, Canada
| | - J M Morris
- From the Departments of Radiology (W.B., J.M.M., H.C., G.L.)
| | - A A Dmytriw
- Joint Department of Medical Imaging (W.B., C.A.H., A.A.D., V.M.P., T.K.), Toronto Western Hospital, Toronto, Ontario, Canada
| | - H Cloft
- From the Departments of Radiology (W.B., J.M.M., H.C., G.L.)
| | - V Mendes Pereira
- Joint Department of Medical Imaging (W.B., C.A.H., A.A.D., V.M.P., T.K.), Toronto Western Hospital, Toronto, Ontario, Canada
| | - G Lanzino
- From the Departments of Radiology (W.B., J.M.M., H.C., G.L.).,Neurosurgery (W.B., G.L.), Mayo Clinic, Rochester, Minnesota
| | - T Krings
- Joint Department of Medical Imaging (W.B., C.A.H., A.A.D., V.M.P., T.K.), Toronto Western Hospital, Toronto, Ontario, Canada
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Singh R, Lucke-Wold B, Gyure K, Boo S. A Review of Vascular Abnormalities of the Spine. ANNALS OF VASCULAR MEDICINE AND RESEARCH 2017; 3. [PMID: 28191502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 09/28/2022]
Abstract
Patients with spinal vascular lesions present with unique symptoms and have important anatomical and physiologic changes that must be considered prior to treatment. In this mini-review, we provide an overview of normal spinal vascular anatomy and discuss several key spinal vascular lesions. We provide an overview of cavernous malformations, intradural arteriovenous malformations, perimedullary arteriovenous fistulas, and dural arteriovenous fistulas. Important considerations are addressed in terms of pathologic characterization, specific imaging findings, and treatment approaches.
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Affiliation(s)
- Rahul Singh
- Department of Neurosurgery, West Virginia University, USA
| | | | | | - Sohyun Boo
- Department of Neuroradiology and Interventional Neuroradiology, West Virginia University, USA
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