Skip to main content

Advertisement

SpringerLink
Log in

Angioarchitecture of the Normal Lateral Spinal Artery and Craniocervical Junction Arteriovenous Fistula Using Contrast-enhanced Cone-beam CT

  • Original Article
  • Published:
Clinical Neuroradiology Aims and scope Submit manuscript

Abstract

Background and Purpose

The lateral spinal artery (LSA) perfuses the dorsolateral part of the spinal cord at the craniocervical junction (CCJ). We analyzed the angioarchitecture of the normal LSA and CCJ arteriovenous fistula (AVF).

Methods

The first study included 26 patients with a cerebral aneurysm of the posterior circulation. Using slab maximum intensity projection (MIP) images from three-dimensional rotational angiography (3D-RA) and contrast-enhanced cone-beam CT (CE-CBCT), we analyzed the origin of the LSA, its anastomosis with the posterior inferior cerebellar artery (PICA), the point where it reaches the spinal cord, and the visualized range. In the second study, we analyzed the angioarchitecture and treatment results of 7 CCJAVF lesions treated in our department between 2016 and 2021.

Results

We visualized the normal LSA for all patients. In 23 patients with an intradural origin PICA, all LSAs originated from the C1 or C2 radicular artery, and 8 patients had an anastomosis with the PICA. In three patients with a C1 level origin PICA, all LSAs originated from the PICA. All LSAs reached the dorsolateral part of the spinal cord. The mean visualized range of the LSA was 27.4 mm. The LSA was involved in five of seven CCJAVF lesions (71%). There was one lesion with a spinal infarction after LSA embolization. Other lesions were treated by direct interruption of the AVF, and the ASA and LSA were preserved.

Conclusion

This is the first report that visualized the LSA’s normal anatomy using slab MIP images from 3D-RA and CE-CBCT. Knowledge of LSA anatomy is critical to avoid complications during the treatment of CCJAVF.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Lasjaunias P, Vallee B, Person H, Ter Brugge K, Chiu M. The lateral spinal artery of the upper cervical spinal cord. Anatomy, normal variations, and angiographic aspects. J Neurosurg. 1985;63:235–41. https://doi.org/10.3171/jns.1985.63.2.0235.

    Article  CAS  PubMed  Google Scholar 

  2. Mercier PH, Brassier G, Fournier HD, Picquet J, Papon X, Lasjaunias P. Vascular microanatomy of the pontomedullary junction, posterior inferior cerebellar arteries, and the lateral spinal arteries. Interv Neuroradiol. 2008;14:49–58. https://doi.org/10.1177/159101990801400107.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Hiramatsu M, Ishibashi R, Suzuki E, Miyazaki Y, Murai S, Takai H, Takasugi Y, Yamaoka Y, Nishi K, Takahashi Y, Haruma J, Hishikawa T, Yasuhara T, Chin M, Matsubara S, Uno M, Tokunaga K, Sugiu K, Date I. Incidence and clinical characteristics of spinal arteriovenous shunts: hospital-based surveillance in Okayama, Japan. J Neurosurg Spine. 2021;36:670–7. https://doi.org/10.3171/2021.7.SPINE21233.

    Article  PubMed  Google Scholar 

  4. Hiramatsu M, Sugiu K, Ishiguro T, Kiyosue H, Sato K, Takai K, Niimi Y, Matsumaru Y. Angioarchitecture of arteriovenous fistulas at the craniocervical junction: a multicenter cohort study of 54 patients. J Neurosurg. 2018;128:1839–49. https://doi.org/10.3171/2017.3.JNS163048.

    Article  PubMed  Google Scholar 

  5. Kiyosue H, Matsumaru Y, Niimi Y, Takai K, Ishiguro T, Hiramatsu M, Tatebayashi K, Takagi T, Yoshimura S, JSNET Spinal AV Shunts Study Group. Angiographic and clinical characteristics of thoracolumbar spinal epidural and dural arteriovenous fistulas. Stroke. 2017;48:3215–22. https://doi.org/10.1161/STROKEAHA.117.019131.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Takai K, Endo T, Seki T, Inoue T, Koyanagi I, Mitsuhara T, Neurospinal Society of Japan CCJ AVF Study Investigators. Neurosurgical versus endovascular treatment of craniocervical junction arteriovenous fistulas: a multicenter cohort study of 97 patients. J Neurosurg. 2021; https://doi.org/10.3171/2021.10.JNS212205.

    Article  PubMed  Google Scholar 

  7. Tanoue S, Endo H, Hiramatsu M, Matsumaru Y, Matsumoto Y, Sato K, Tsuruta W, Sato M, Hirohata M, Abe T, Kiyosue H, JSNET VADA study group. Delineability and anatomical variations of perforating arteries from normal vertebral artery on 3D DSA: implications for endovascular treatment of dissecting aneurysms. Neuroradiology. 2021;63:609–17. https://doi.org/10.1007/s00234-020-02549-y.

    Article  PubMed  Google Scholar 

  8. Siclari F, Burger IM, Fasel JH, Gailloud P. Developmental anatomy of the distal vertebral artery in relationship to variants of the posterior and lateral spinal arterial systems. AJNR Am J Neuroradiol. 2007;28:1185–90. https://doi.org/10.3174/ajnr.A0498.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Sato K, Endo T, Niizuma K, Fujimura M, Inoue T, Shimizu H, Tominaga T. Concurrent dural and perimedullary arteriovenous fistulas at the craniocervical junction: case series with special reference to angioarchitecture. J Neurosurg. 2013;118:451–9. https://doi.org/10.3171/2012.10.JNS121028.

    Article  PubMed  Google Scholar 

  10. Endo T, Shimizu H, Sato K, Niizuma K, Kondo R, Matsumoto Y, Takahashi A, Tominaga T. Cervical perimedullary arteriovenous shunts: a study of 22 consecutive cases with a focus on angioarchitecture and surgical approaches. Neurosurgery. 2014;75:238–49. https://doi.org/10.1227/NEU.0000000000000401.

    Article  PubMed  Google Scholar 

  11. Goto Y, Hino A, Shigeomi Y, Oka H. Surgical management for craniocervical junction arteriovenous fistula targeting the intradural feeder. World Neurosurg. 2020 Dec;144:e685–92. https://doi.org/10.1016/j.wneu.2020.09.041

    Article  PubMed  Google Scholar 

  12. Hiramatsu M, Sugiu K, Yasuhara T, Hishikawa T, Haruma J, Takahashi Y, Murai S, Nishi K, Yamaoka Y, Date I. Detection of the common origin of the radiculomedullary artery with the feeder of spinal dural arteriovenous fistula using slab maximum intensity projection image. Neuroradiology. 2020;62:1285–92. https://doi.org/10.1007/s00234-020-02466-0.

    Article  PubMed  Google Scholar 

  13. Ryu B, Sato S, Takase M, Mochizuki T, Shima S, Inoue T, Okada Y, Niimi Y. Diagnostic accuracy of three-dimensional-rotational angiography and heavily T2-weighted volumetric magnetic resonance fusion imaging for the diagnosis of spinal arteriovenous shunts. J Neurointerv Surg. 2022; https://doi.org/10.1136/neurintsurg-2020-017252.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurological Surgery, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, 700-8558, Okayama, Japan

    Masafumi Hiramatsu, Kenji Sugiu, Takao Yasuhara, Tomohito Hishikawa, Jun Haruma, Kazuhiko Nishi, Yoko Yamaoka, Yuki Ebisudani, Hisanori Edaki, Ryu Kimura & Isao Date

Authors
  1. Masafumi Hiramatsu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kenji Sugiu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Takao Yasuhara
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tomohito Hishikawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jun Haruma
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Kazuhiko Nishi
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Yoko Yamaoka
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Yuki Ebisudani
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Hisanori Edaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Ryu Kimura
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Isao Date
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Masafumi Hiramatsu.

Ethics declarations

Conflict of interest

M. Hiramatsu and K. Sugiu disclose financial interests, which is payment for lectures and travel expenses unrelated to the present work submitted for publication from Siemens Healthcare. T. Yasuhara, T. Hishikawa, J. Haruma, K. Nishi, Y. Yamaoka, Y. Ebisudani, H. Edaki, R. Kimura and I. Date declare that they have no competing interests.

Additional information

Portions of this work were presented orally at the 16th Congress of World Federation of Interventional and Therapeutic Neuroradiology, which was held on August 21–25, 2022, in Kyoto, Japan.

Rights and permissions

Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hiramatsu, M., Sugiu, K., Yasuhara, T. et al. Angioarchitecture of the Normal Lateral Spinal Artery and Craniocervical Junction Arteriovenous Fistula Using Contrast-enhanced Cone-beam CT. Clin Neuroradiol 33, 375–382 (2023). https://doi.org/10.1007/s00062-022-01218-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00062-022-01218-2

Keywords

Search

Navigation