Collateral pathways to the artery of Adamkiewicz

Clip Ligation and Disconnection of a Ruptured Ventral Subaxial Cervical Isolated Spinal Aneurysm Using Tailored Access Osteotomies: An Operative Technique

“…30 The redundant VPP nature links pial branches of nearby RMAs, making endovascular embolization of RPAs safer, although not without risk. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15]30 Microsurgical RPA occlusion is safe in principle, although distinguishing a vRPA from an RMA branch can be difficult in practice. As such, treatment of SAs through the ventral access is typically reported as endovascular embolization or diversion, with aneurysms associated with AVFs and AVMs commonly reported owing to prevalence and the hypertrophied, high-flow state of involved vasculature.…”

“…[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] Rupture carries a high rate of morbidity, typically through acute spinal cord injury. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] Treatment strategies feature conservative, endovascular, open, and multimodal options. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] iSAs of the ventral spinal axis, particularly around the cervical enlargement, are often managed by conservative measures secondary to small vessel caliber, eloquent angioarchitecture, and inaccessible anatomy.…”

“…[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] Treatment strategies feature conservative, endovascular, open, and multimodal options. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] iSAs of the ventral spinal axis, particularly around the cervical enlargement, are often managed by conservative measures secondary to small vessel caliber, eloquent angioarchitecture, and inaccessible anatomy. 3,4,6,9,11,13,[16][17][18][19][20][21][22][23] Surgical and endovascular options are limited by safe access, typically for iSAs located distal to the cervical enlargement, where large caliber vessels and increased working room make conditions more favorable.…”

“…solated spinal aneurysms (iSAs) are generally fusiform lesions of the spinal vasculature with no associated vascular malformation which typically present ruptured as spontaneous subarachnoid hemorrhage (sSAH) along small vessel segments, affecting the anterior spinal artery (ASA), segmental radiculomedullary (RMA), or ventral radiculopial (vRPA) arteries in over 75% of cases. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] Rupture carries a high rate of morbidity, typically through acute spinal cord injury. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] Treatment strategies feature conservative, endovascular, open, and multimodal options.…”