Microsurgical considerations of the anterior spinal and the anterior-ventral spinal arteries

Santos-Franco, Jorge Arturo; Oliveira, Evandro de; Mercado, Roger Z. Ríos; Ortiz-Velázquez, Rogelio Iván; Revuelta-Gutiérrez, Rogelio; Gómez-Llata, Sergio

doi:10.1007/s00701-005-0663-7

Cited by 10 publications

(4 citation statements)

References 37 publications

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“…11 In fact in another human cadaver series the 'typical' bilateral origin of the anterior spinal artery was the least common variant. 12 Therefore, the mechanism and location of the stroke in our case can be explained by either thrombotic occlusion of a lone unilateral right anterior spinal artery where it arises from the right vertebral artery, or by an occlusion of a small penetrating artery by an embolus from the atherosclerotic right vertebral artery.…”

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confidence: 72%

Anterior Spinal Artery Infarction at the Cervicomedullary Junction

Gofton

Barber

2006

Can. j. neurol. sci.

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An 81-year-old right handed man presented with bilateral leg weakness. The patient had been previously independent and was medicated with warfarin for atrial flutter. He had longstanding type 2 diabetes, controlled by oral hypoglycemic medication. At presentation, he reported sudden onset left sided weakness with accompanying neck pain at 22h00 the previous evening. Pertinent findings on neurological examination included a left pronator drift and profound left leg weakness with unsustained antigravity strength. Deep tendon reflexes were brisk throughout but absent at the ankles and there was a left extensor plantar response. Cranial nerve and sensory examinations were normal.The following day there was a profound deterioration in the patient's neurological status, with weakness progressing to involve both legs. Cranial nerve examination was normal apart from significant hypophonia of speech. Palatal movements were normal. Tone was reduced in the left arm, left leg and right leg but was normal in the right arm. There was pyramidal weakness of the left arm with 2/5 power and of the legs with 1/5 power on the left and 3/5 on the right. Reflexes were absent at the left ankle, 1+ at the right ankle and 2+ and brisk in the remainder. Strength was normal in the right arm. Extensor plantar reflexes were present bilaterally. Sensory examination revealed a subtle diminution in pinprick sensation at the level of the C2 dermatome and below with normal light touch, vibration and proprioception throughout.Initial magnetic resonance imaging (MRI) of the brain, including diffusion weighted imaging (DWI), and the cervical spine was reported normal, although the vascular abnormalities of the right vertebral artery had been commented upon and are referred to below on subsequent imaging. Laboratory investigations revealed normal blood work and cerebrospinal fluid. Repeat MR imaging of the cervicomedullary junction, 11 days later, revealed a hyperintense lesion on T2 of the medullary pyramids also involving the upper anterior portion of the cervical spinal cord (see Figure 1A,B) with corresponding reduced apparent diffusion coefficient ( Figure 1C,D). Also seen in Figure 1 is a hyperintense signal in the right vertebral artery (Figure 1, arrow) suggesting either slow blood flow or vascular occlusion. Three-Dimensional time of flight MR angiography (MRA) revealed minimal flow within the proximal vertebral artery on the right, followed by a long segment of absent flow distally (Figure 2). There were multifocal areas of stenosis within the fourth segment of the right vertebral artery with a tight area of stenosis in the distal right fourth segment (Figure 2, arrow 1). The left vertebral and basilar artery and the remainder of the posterior circulation are normal. The right posterior inferior cerebellar artery (PICA) was patent ( Figure 2, arrow 2).The unifying diagnosis was infarction of cervicomedullary junction secondary to occlusion of the anterior spinal artery at the origin of the right vertebral artery.Anterior spinal artery syn...

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confidence: 72%

Anterior Spinal Artery Infarction at the Cervicomedullary Junction

Gofton

Barber

2006

Can. j. neurol. sci.

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“…High anatomical variability of the ASA origin exists, and it often has either a predominance of one ramus over the other or a sole unilateral ramus of origin ( 11 , 12 ). The Santos-Franco et al study reported a less typical bilateral origin of the ASA ( 13 ).…”

Section: Cervical Asa Anatomymentioning

confidence: 95%

Role of the Cervical Anterior Spinal Artery in the Endovascular Treatment of Vascular Diseases: Bystander, Accomplice, Victim, or Friend?

Zhang

Hou

et al. 2021

Front. Neurol.

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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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“…La AB presenta evidentes variaciones en su expresión morfológica relacionadas con su origen, longitud, trayectoria y calibre (Torche et al, 1992;Akar et al, 1994;Schulte-Altedorneburg et al, 2000;Mandiola et al, 2004;Pai et al, 2007;Songur et al, 2008). Además del surco pontomedular, esta puede originarse por debajo o por arriba de este surco referente (Stopford, 1916;Wojtowicz et al, 1989;Santos-Franco et al, 2006;Stopforf;Songur et al).…”

Section: Introductionunclassified

“…Las variaciones de la AB no determinan per se, diferencias en el suministro de sangre en los territorios irrigados, pero las variaciones sumadas a otros factores como estenosis, ateromatosis, embolia o trombosis son causa de cuadros clínicos originados en el tallo cerebral (Wollschlaeger et al, 1967;Schulte-Altedorneburg et al;Pico et al, 2006;Deng et al, 2012). Las expresiones morfológicas de la AB han sido descritas mediante técnicas de disección clásica, inyección de sus lechos vasculares o estudios imagenológicos en otros grupos poblacionales (Stopford;Smoker et al,;Mandiola et al, 1995;Pai et al;Santos-Franco et al;Wojtowicz et al). Con el propósito de obtener información propia de referencia, este estudio contó con muestras cadavéricas frescas de sujetos colombianos.…”

Section: Introductionunclassified