?????? (Vascular diseases of spinal cord)

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?????? (Vascular diseases of spinal cord)

• Neurosurgeon
• Yoon Seung-Hwan

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??? ??
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Arterial system

• Anterior spinal artery
• ?? vertebral artery? anterior spinal rami?
• ???? ???? ?? ?? anterior radicular
• artery ? ??? ?? ??? ???? ????
• 1. Upper or cervicothoracic territory
• 2. Intermediate or middle thoracic territory
• 3. Lower or thoracolumbar territory

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Upper or cervicothorcic territory

• ?? ?? anterior spinal rami of vertebral artery
• ?? ?? branches of vertebral artery
• ?? ?? branches of subclavian artery

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Intermediated or middle thoraicc territory

• T4-T8 thoracic cord area
• 2-3 anterior radicular arteries

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Lower or thoracolumbar territory

• ??? 3-4 thoracic cord ? ?? ??
• Adamkiewicz artery
• ? ?? ? ??, T9 to L2 ?? ??? ??
• ?? ???? ???

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Posterior spinal artery

• Origin from vertebral artery
• Bypass foramen magnum
• ??? 2?? ????.

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Central spinal artery

• Branches of anterior spinal artery
• Through anterior sulcus of cord
• To anterior white commissure

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Venous system

• Intermedullary vein
• anterior median vein
• posterior median vein
• Peirmedullary vein, venous vasocorona
• anterior and posterior spinal vein
• posterolateral and anterolateral vein
• Radicular vein
• venous plexus ? ??? ????

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• ????? ???
• radicular vein internal vertebral venosus
  plxus,
• Batson plexus ???? ???
• or azygos vein ???

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?? ???? ??

• Autoregulation mechanism
• ????? ?? ????? ?????
• ??? ????? ????? ?????
• ?? ????.

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??? ??????

• ??
• 1. ??? ?? ??? ?? ????
• (?????, ???, ????)
• 2. ?? ?? ?? ??? ?? ?? ???? ?? ?? ??
• (???????, ??? ??, ??? ???)
• 3. ?? ????? ?? ????(???, ?????)
• 4. ??? ????? ?? ????(???, ??? ????)
• 5. ????????? ?? ?? ??(????,
• ??? ????, ???)
• 6. ??? ????? ?? ????(??? ????)

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??

• Transient ischemic attack ??? ???
• Spinal cord infarction
• anterior spinal artery occlusive syndrome
• ?? emboli
• posterior spinal artery thrombosis
• central artery syndrome

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Hemorrhage

• Suddenly back pain
• Cord compression symptoms
• Etiology
• trauma, vessel anomaly, tumor
• blood dyscrasia, atherosclerosis

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• Epidural hemorrhage
• Subdural hemorrhage
• Spinal SAH
• Hematomyelia

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Epidural hemorrhage

• ??gt
• 2-3 ? ??? ??? ??
• Backpain radicular symptoms,
• cord compression Sx sign
• D.Dx
• epidrual abscess, HNP, cord tumor
• dissecting aneurysm
• Tx
• decompressive laminectomy rapidly, if
  possble

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Subdural hemorrhage

• Rare
• gt lower thoracic and TL junction

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Subarchnoid hemorrhage

• Etiology
• vessel anomaly, aneurym,
• Coarctation of aorta, collagen disease,
• anticoaluate agent
• Symptom and sign
• backpain and radicular symptom
• meningeal irritation sign
• D.Dx
• s-SAH on brain

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Hematomyelia

• Rare
• Clinical findings
• Tx
• similar to spinal cord infarction
• spontaneous resolutions
• large hematoma - removal

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Vascular anomaly

• Embriologic anomaly 3-6 weeks
• Dx
• MRI, CT, spinal angiolgraphy

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Classification

• Type ? single, coiled, unbranched type
• Type ? glomus type
• Type ? Juvenile type
• High flow ???? ?? ??????? contrast
• clearance? 5???
• Low flow

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?? ??

• 3.3 ?? 40
• ??gt
• TL junction 60
• Upper thoracic 28
• cervical 12
• ?? ?? 80gt

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????

• ?? ?? ????? ???
• ???
• ?????
• ??, ????, ??? ??
• ??? --- ???? ??--- ??? ??

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Pathogeneisis

• Mechanical compression
• Vascular steal phenomenon

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Diagnosis

• MRI signal void
• Myelogram serpentine filling defect
• Selective spinal angiography - confirm

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Treatment

• Single, coiled type and glomus type
• ???? ?? ??
• Juvenile type- ???? ?? ??? ???