Microsurgical anatomy of the Adamkiewicz artery-anterior spinal artery junction
Microsurgical anatomy of the Adamkiewicz artery-anterior spinal artery junction
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DOI：
10.1007/s00276-015-1596-3
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发表时间：
2016-07-01
影响因子：
1.4
通讯作者：
Peltier, Johann
中科院分区：
文献类型：
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作者：
N'da, Hermann Adonis;Chenin, Louis;Peltier, Johann
本研究的目的是描述脊髓前动脉 - Adamkiewicz 动脉 (ASA-AKA) 交界处，并建立一个分类，以定义胸腹主动脉瘤治疗以及前路或经椎间孔胸腰椎手术中的神经风险。解剖了 15 具新鲜尸体的脊髓。腰动脉和 ASA 均注射强稀释的红色硅。AKA 硬膜交叉点位于左侧（86%），T8 和 T10 之间（73.33%），L1-L2（26.67%）。 AKA升支的平均直径为1.10 mm（范围0.8-1.9 mm），平均长度为30.27 mm（范围12.3-60 mm）。 AKA 的牙弓平均直径为 11.3 毫米（范围 9-20 毫米），开口向下平均角度为 20.1A 度（范围 11A 度-30A 度）。 AKA 的降支是 ASA 的延续，平均直径为 1.33 mm（范围 0.8-1.86 mm）。足弓顶部的 ASA 平均直径为 0.74 毫米（范围 0.2-1.77 毫米）。根据这些发现，我们提出了一种具有两种类型连接点的新分类。 93.33% 的病例中存在与高神经系统风险相关的 I 型及其变异体。 II 型与中度或低度神经系统风险相关，出现在 6.67% 的病例中。这些解剖学发现允许在胸腹主动脉瘤或胸腰椎前路或经椎间孔脊柱手术之前规划神经系统风险。
The aim of this study is to describe the anterior spinal artery-Adamkiewicz artery (ASA-AKA) junction and establish a classification allowing defining the neurological risk in either thoracoabdominal aorta aneurysm treatment and in anterior or transforaminal thoracolumbar spine surgery.Fifteen spinal cords of fresh cadavers were dissected. Both lumbar arteries and ASA were injected with strongly diluted red-colored silicon.The dural crossing of AKA was located on the left side in 86 % of cases, between T8 and T10 in 73.33 % of cases and L1-L2 in 26.67 % of cases. The average diameter of the ascending branch of AKA was 1.10 mm (range 0.8-1.9 mm), and its average length was 30.27 mm (range 12.3-60 mm). The AKA's arch average diameter was 11.3 mm (range 9-20 mm) with an open downward angle average of 20.1A degrees (range 11A degrees-30A degrees). The descending branch of AKA which was a continuation of ASA had an average diameter of 1.33 mm (range 0.8-1.86 mm). The ASA at the top of the arch had an average diameter of 0.74 mm (range 0.2-1.77 mm). According to these findings, we have proposed a new classification with two types of junctions. The type I and its variant correlated to high neurological risk were present in 93.33 % of cases. The type II, correlated to medium or low neurological risk, was present in 6.67 % of cases.These anatomical findings allow a planning of the neurological risk before thoracoabdominal aorta aneurysm or thoracolumbar anterior or transforaminal spine surgery.