Magnetic resonance angiography and neuromonitoring to assess spinal cord blood supply in thoracic and thoracoabdominal aortic aneurysm surgery Robbert.

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Presentation transcript:

Magnetic resonance angiography and neuromonitoring to assess spinal cord blood supply in thoracic and thoracoabdominal aortic aneurysm surgery Robbert J. Nijenhuis, MD, Michael J. Jacobs, MD, PhD, Geert W. Schurink, MD, PhD, Alphons G.H. Kessels, MD, Jos M.A. van Engelshoven, MD, PhD, Walter H. Backes, PhD Journal of Vascular Surgery Volume 45, Issue 1, Pages 71-78 (January 2007) DOI: 10.1016/j.jvs.2006.08.085 Copyright © 2007 The Society for Vascular Surgery Terms and Conditions

Fig 1 Coronal multiplanar reformations of preoperative magnetic resonance (MR) angiography images in a 69-year-old male patient with a Crawford type I aortic aneurysm. Images show the Adamkiewicz artery (AKA) (white arrow) and the great anterior radiculomedullary vein (GARV) (black arrows) on the anterior surface of the spinal cord in the first (a) and second (b) phase of the MR angiogram. Note the similar spatial configuration and, thus, appearance of the inlet artery and outlet vein. In the second phase, the signal intensity of the AKA diminishes while the signal intensity of the GARV increases. Journal of Vascular Surgery 2007 45, 71-78DOI: (10.1016/j.jvs.2006.08.085) Copyright © 2007 The Society for Vascular Surgery Terms and Conditions

Fig 2 Preoperative magnetic resonance angiography showing an example of the direct segmental supply to the Adamkiewicz artery (AKA) in a 70-year-old male patient with a Crawford type II aortic aneurysm. The segmental artery (SA) supplying the AKA and anterior spinal artery (ASA) is open (ie, not occluded) and derives at the same vertebral level as the AKA. Journal of Vascular Surgery 2007 45, 71-78DOI: (10.1016/j.jvs.2006.08.085) Copyright © 2007 The Society for Vascular Surgery Terms and Conditions

Fig 3 Preoperative magnetic resonance angiography showing an example of the collateral (indirect) segmental supply to the Adamkiewicz artery (AKA) in a 63-year-old male patient with a Crawford type I aortic aneurysm. The segmental artery (SA*) directly connecting to the AKA is partially occluded. The AKA is supplied by a intersegmental collateral (COL), which originates from a segmental artery (SA) one vertebral level below. Journal of Vascular Surgery 2007 45, 71-78DOI: (10.1016/j.jvs.2006.08.085) Copyright © 2007 The Society for Vascular Surgery Terms and Conditions

Fig 4 Overview of the localization (in terms of side and vertebral level) of the Adamkiewicz artery (white bars) and great anterior radiculomedullary vein (black bars) by magnetic resonance angiography in 60 thoracic and thoracoabdominal aortic aneurysm patients. The bar length indicates the number of patients in whom the vessel was found at that particular vertebral level. Journal of Vascular Surgery 2007 45, 71-78DOI: (10.1016/j.jvs.2006.08.085) Copyright © 2007 The Society for Vascular Surgery Terms and Conditions

Fig 5 Schematic representation of the number of patients in whom the motor evoked potentials declined or remained stable when the segmental supplier of the Adamkiewicz artery was or was not cross-clamped. Journal of Vascular Surgery 2007 45, 71-78DOI: (10.1016/j.jvs.2006.08.085) Copyright © 2007 The Society for Vascular Surgery Terms and Conditions