Interruption of the bilateral segmental arteries at several levels - Influence on vertebral blood flow
Interruption of the bilateral segmental arteries at several levels - Influence on vertebral blood flow
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DOI：
10.1097/01.brs.0000131420.32770.06
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发表时间：
2004-07-15
期刊：
影响因子：
3
通讯作者：
Tomita, K
中科院分区：
文献类型：
--
作者：
Nambu, K;Kawahara, N;Tomita, K
研究设计。目的研究在T11、T12和T13水平结扎双侧节段动脉对T12椎体血流量的影响。目的：确定在1~3个椎体水平双侧节段动脉阻断所引起的椎体血流量的减少。在多血管脊柱肿瘤患者中，术中出血有时是巨大的，特别是在根治性切除术中，如脊柱全块切除术。新的栓塞术的发展使得脊柱肿瘤的术前栓塞术更具侵袭性、更广泛、更安全。对12只雌性犬的T12椎体在1~3个节段动脉结扎后的血流量进行了测量。在此过程中记录脊髓诱发电位。对另外10只狗在夹断双侧节段动脉后，用硅化合物进行脊髓血管造影术。T12椎体血流量结扎双侧T12椎段动脉后降至对照组的70.13+/-6.37%，结扎双侧T12椎段动脉及T11或T13椎体血流量分别为46.48+/-8.97%和24.11+/-8.31%。结扎和切开T12及T12两个平面后的血管造影显示T12节段动脉远端切开处有较厚清晰的造影剂。然而，在T11、T12和T13三个节段阻断后，血管造影上可见T12节段动脉的远端切断处细小而模糊。结扎3个节段动脉后，6只犬的脊髓诱发电位均无明显变化。阻断双侧节段动脉，1个靶椎和2个相邻椎体，使犬下胸椎的靶椎血流量减少到对照的1/4。提示在多血管脊柱肿瘤全椎体切除术中，肿瘤椎体及其上下三个平面的椎体栓塞术可以有效地减少术中出血。
Study Design. The effect of ligation of the bilateral segmental arteries at the levels of T11, T12, and T13 on blood flow of the T12 vertebra was studied in a dog model.Objectives. To determine the reduction of the vertebral blood flow resulting from interruption of bilateral segmental arteries at one to three vertebral levels.Summary of Background Data. Intraoperative hemorrhage can be sometimes massive in patients with hypervascular spinal tumors, especially in radical resection such as total en bloc spondylectomy. The recent development of new embolization techniques ensures more aggressive, more extensive, and safer preoperative embolization for spinal tumors.Methods. The blood flow of the T12 vertebra of 12 female dogs was measured after ligation of the bilateral segmental arteries at one to three levels, including the T12. Spinal cord evoked potentials were recorded in this procedure. Spinal angiography using a silicon compound was performed on another 10 dogs after clipping and section of the bilateral segmental arteries.Results. The blood flow of the T12 vertebra decreased to 70.13 +/- 6.37% of the control value after ligation of the bilateral segmental arteries of T12, to 46.48 +/- 8.97% after ligation of the bilateral segmental arteries of T12 and either T11 or T13, to 24.11 +/- 8.31% after ligation of T11, T12, and T13, respectively. The angiogram after ligation and section of T12 and the two levels including T12 showed thick and clear contrast medium in the cut distal ends of the T12 segmental arteries. After interruption at three levels ( T11, T12, and T13), however, the cut distal ends of the T12 segmental arteries were seen thin and faint on the angiogram. No significant changes occurred in spinal cord evoked potentials after ligation of the segmental arteries at three levels in all six dogs.Conclusion. Interruption of the bilateral segmental arteries at three levels, one target vertebra and the two adjacent vertebrae, reduced the blood flow of the target vertebra to one fourth of the control value in the lower thoracic spine in dogs. This result suggests that preoperative embolization at three levels, the levels of the tumor vertebra and the adjacent vertebrae above and below it, may reduce intraoperative hemorrhage effectively during total en bloc spondylectomy for hypervascular spinal tumors.