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Semin Neurol 2023; 43(03): 356-369
DOI: 10.1055/s-0043-1771209
Review Article

Functional Vascular Anatomy and Arteriovenous Shunts of the Spine

Takahiro Ota
1   Department of Neurosurgery, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
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Abstract

The history of vascular anatomy of the spinal cord and spine began in the late 19th century. With recent advances in endovascular and surgical treatment of vascular lesions of the spinal cord, understanding the vascular anatomy of the spinal cord has become more important than ever. Catheter angiography is the gold standard for diagnosing vascular lesions of the spinal cord, and the vascular architecture of the spinal cord itself is relatively simple, a repetition of basic longitudinal and axial structures. This review discusses the vascular anatomy of the spine and spinal cord from the embryological point of view, as well as an overview of typical spinal arteriovenous shunt diseases mainly depending on their locations: paraspinal, epidural, dural, perimedullary, intramedullary, filum terminale/cauda equina, craniocervical junction, and related diseases.

Keywords

functional anatomy - embryology - arteriovenous shunt - spine - spinal cord


Publication History

Article published online:
03 August 2023

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  • References

  • 1 Groen RJM, Grobbelaar M, Muller CJF. et al. Morphology of the human internal vertebral venous plexus: a cadaver study after latex injection in the 21-25-week fetus. Clin Anat 2005; 18 (06) 397-403
    CrossrefPubMedGoogle Scholar
  • 2 Diaz-Cuadros M, Wagner DE, Budjan C. et al. In vitro characterization of the human segmentation clock. Nature 2020; 580 (7801) 113-118
    CrossrefPubMedGoogle Scholar
  • 3 Pourquie O. The vertebrate segmentation clock. J Anat 2001; 199 (Pt 1-2): 169-175
    CrossrefPubMedGoogle Scholar
  • 4 Schoenwolf G, Bleyl S, Brauer P, Francis-West P. Larsen's Human Embryology. 5th ed. Elsevier; 2015
    Google Scholar
  • 5 Costa Almeida L, de Souza Figueiredo YJ, Pinheiro Zylberman A, Garção DC. Ascent of the conus medullaris in human foetuses: a systematic review and meta-analysis. Sci Rep 2022; 12 (01) 12659
    CrossrefPubMedGoogle Scholar
  • 6 Lazorthes G, Gouaze A, Zadeh JO, Santini JJ, Lazorthes Y, Burdin P. Arterial vascularization of the spinal cord. Recent studies of the anastomotic substitution pathways. J Neurosurg 1971; 35 (03) 253-262
    CrossrefPubMedGoogle Scholar
  • 7 Evans H. The development of the vascular system. In: In Manual of Human Embryology. J.B. Lippincott Co.; 1912: 570-709
    Google Scholar
  • 8 Gregg L, Gailloud P. Neurovascular anatomy; spine. In: Hetts S, Cooke D. eds. Handbook of Clinical Neurology. Elsevier B.V.; 2021: 33-47
    Google Scholar
  • 9 Manelfe C, Lazorthes G, Roulleau J. Arteries of the human spinal dura mater. [Article in French]. Acta Radiol Diagn (Stockh) 1972; 13 (00) 829-841
    PubMedGoogle Scholar
  • 10 Bosmia AN, Hogan E, Loukas M, Tubbs RS, Cohen-Gadol AA. Blood supply to the human spinal cord: part I. Anatomy and hemodynamics. Clin Anat 2015; 28 (01) 52-64
    CrossrefPubMedGoogle Scholar
  • 11 Lasjaunias P, Berensterin A, ter Brugge KG. Surgical Neuroangiography. Clinical Vascular Anatomy and Variations. Vol. 1. 2nd ed. New York: Springer; 2001
    CrossrefGoogle Scholar
  • 12 Zawiliński J, Litwin JA, Nowogrodzka-Zagórska M, Gorczyca J, Miodoński AJ. Vascular system of the human spinal cord in the prenatal period: a dye injection and corrosion casting study. Ann Anat 2001; 183 (04) 331-340
    CrossrefPubMedGoogle Scholar
  • 13 Sakka L, Gabrillargues J, Coll G. Anatomy of the spinal meninges. Oper Neurosurg (Hagerstown) 2016; 12 (02) 168-188
    CrossrefPubMedGoogle Scholar
  • 14 Griessenauer CJ, Raborn J, Foreman P, Shoja MM, Loukas M, Tubbs RS. Venous drainage of the spine and spinal cord: a comprehensive review of its history, embryology, anatomy, physiology, and pathology. Clin Anat 2015; 28 (01) 75-87
    CrossrefPubMedGoogle Scholar
  • 15 Gregg L, Gailloud P. Transmedullary venous anastomoses: anatomy and angiographic visualization using flat panel catheter angiotomography. AJNR Am J Neuroradiol 2015; 36 (07) 1381-1388
    CrossrefPubMedGoogle Scholar
  • 16 Niimi Y, Berenstein A, Fernandez PM, Brisman JL, Song JK. Pediatric nonvertebral paraspinal arteriovenous fistulas along the segmental nerve: clinical, imaging, and therapeutic considerations. J Neurosurg 2005; 103 (02) 156-162
    PubMedGoogle Scholar
  • 17 Kim LJ, Spetzler RF. Classification and surgical management of spinal arteriovenous lesions: arteriovenous fistulae and arteriovenous malformations. Neurosurgery 2006; 59 (05, Suppl 3): S195-S201 , discussion S3–S13
    PubMedGoogle Scholar
  • 18 Veznedaroglu E, Nelson PK, Jabbour PM, Rosenwasser RH. Endovascular treatment of spinal cord arteriovenous malformations. Neurosurgery 2006; 59 (05, Suppl 3): S202-S209 , discussion S3–S13
    CrossrefPubMedGoogle Scholar
  • 19 Mizutani K, Consoli A, Maria FD. et al. Intradural spinal cord arteriovenous shunts in a personal series of 210 patients: novel classification with emphasis on anatomical disposition and angioarchitectonic distribution, related to spinal cord histogenetic units. J Neurosurg Spine 2021; 34: 1-11
    CrossrefPubMedGoogle Scholar
  • 20 Rodesch G, Lasjaunias P. Spinal cord arteriovenous shunts: from imaging to management. Eur J Radiol 2003; 46 (03) 221-232
    CrossrefPubMedGoogle Scholar
  • 21 Cognard C, Semaan H, Bakchine S. et al. Paraspinal arteriovenous fistula with perimedullary venous drainage. AJNR Am J Neuroradiol 1995; 16 (10) 2044-2048
    PubMedGoogle Scholar
  • 22 Consoli A, Coskun O, Di Maria F. et al. Spinal cord arterio-venous shunts: From classification to therapeutic management. Rev Neurol (Paris) 2021; 177 (05) 469-476
    CrossrefPubMedGoogle Scholar
  • 23 Kitagawa RS, Mawad ME, Whitehead WE, Curry DJ, Luersen TG, Jea A. Paraspinal arteriovenous malformations in children. J Neurosurg Pediatr 2009; 3 (05) 425-428
    CrossrefPubMedGoogle Scholar
  • 24 Lasjaunias P, Berensterin A, ter Brugge KG. Surgical Neuroangiography. 2nd ed. New York: Springer; 2006
    CrossrefGoogle Scholar
  • 25 Elkordy A, Endo T, Sato K, Sonoda Y, Takahashi A, Tominaga T. Exclusively epidural spinal metameric arteriovenous shunts: case report and literature review. Spine J 2015; 15 (03) e15-e22
    CrossrefPubMedGoogle Scholar
  • 26 Ramanathan D, Levitt MR, Sekhar LN, Kim LJ, Hallam DK, Ghodke BV. Management of spinal epidural arteriovenous fistulas: interventional techniques and results. J Neurointerv Surg 2014; 6 (02) 144-149
    CrossrefPubMedGoogle Scholar
  • 27 Huang W, Gross BA, Du R. Spinal extradural arteriovenous fistulas: clinical article. J Neurosurg Spine 2013; 19 (05) 582-590
    CrossrefPubMedGoogle Scholar
  • 28 Lasjaunias P, Berenstein A. Surgical Neuroangiography. Part 3. Functional Vascular Anatomy of the Brain, Spinal Cord and Spine. Berlin, Germany: Springer-Verlag; 1990
    Google Scholar
  • 29 Kiyosue H, Matsumaru Y, Niimi Y. et al; JSNET Spinal AV Shunts Study Group. Angiographic and clinical characteristics of thoracolumbar spinal epidural and dural arteriovenous fistulas. Stroke 2017; 48 (12) 3215-3222
    CrossrefPubMedGoogle Scholar
  • 30 Heier LA, Lee BCP. A dural spinal arteriovenous malformation with epidural venous drainage: a case report. AJNR Am J Neuroradiol 1987; 8 (03) 561-563
    PubMedGoogle Scholar
  • 31 Marshman LAG, David KM, Chawda SJ. Lumbar extradural arteriovenous malformation: case report and literature review. Spine J 2007; 7 (03) 374-379
    CrossrefPubMedGoogle Scholar
  • 32 Kiyosue H, Tanoue S, Okahara M, Hori Y, Kashiwagi J, Mori H. Spinal ventral epidural arteriovenous fistulas of the lumbar spine: angioarchitecture and endovascular treatment. Neuroradiology 2013; 55 (03) 327-336
    CrossrefPubMedGoogle Scholar
  • 33 Brinjikji W, Yin R, Nasr DM, Lanzino G. Spinal epidural arteriovenous fistulas. J Neurointerv Surg 2016; 8 (12) 1305-1310
    CrossrefPubMedGoogle Scholar
  • 34 Aljobeh A, Sorenson TJ, Bortolotti C, Cloft H, Lanzino G. Vertebral arteriovenous fistula: a review article. World Neurosurg 2019; 122: e1388-e1397
    CrossrefPubMedGoogle Scholar
  • 35 Beaujeux RL, Reizine DC, Casasco A. et al. Endovascular treatment of vertebral arteriovenous fistula. Radiology 1992; 183 (02) 361-367
    CrossrefPubMedGoogle Scholar
  • 36 Fugate JE, Lanzino G, Rabinstein AA. Clinical presentation and prognostic factors of spinal dural arteriovenous fistulas: an overview. Neurosurg Focus 2012; 32 (05) E17
    CrossrefPubMedGoogle Scholar
  • 37 Marcus J, Schwarz J, Singh IP. et al. Spinal dural arteriovenous fistulas: a review. Curr Atheroscler Rep 2013; 15 (07) 335
    CrossrefPubMedGoogle Scholar
  • 38 Krings T, Geibprasert S. Spinal dural arteriovenous fistulas. AJNR Am J Neuroradiol 2009; 30 (04) 639-648
    CrossrefPubMedGoogle Scholar
  • 39 Komiyama M. Spinal radiculomedullary vein and bridging vein. Interv Neuroradiol 2020; 26 (06) 703-705
    CrossrefPubMedGoogle Scholar
  • 40 Biondi A, Merland JJ, Reizine D. et al. Embolization with particles in thoracic intramedullary arteriovenous malformations: long-term angiographic and clinical results. Radiology 1990; 177 (03) 651-658
    CrossrefPubMedGoogle Scholar
  • 41 Mourier KL, Gobin YP, George B, Lot G, Merland JJ. Intradural perimedullary arteriovenous fistulae: results of surgical and endovascular treatment in a series of 35 cases. Neurosurgery 1993; 32 (06) 885-891 , discussion 891
    CrossrefPubMedGoogle Scholar
  • 42 Spetzler RF, Detwiler PW, Riina HA, Porter RW. Modified classification of spinal cord vascular lesions. J Neurosurg 2002; 96 (02) 145-156
    PubMedGoogle Scholar
  • 43 Rodesch G, Hurth M, Alvarez H, Tadie M, Lasjaunias P. Spinal cord intradural arteriovenous fistulae: anatomic, clinical, and therapeutic considerations in a series of 32 consecutive patients seen between 1981 and 2000 with emphasis on endovascular therapy. Neurosurgery 2005; 57 (05) 973-983 , discussion 973–983
    CrossrefPubMedGoogle Scholar
  • 44 Li J, Zeng G, Zhi X. et al. Pediatric perimedullary arteriovenous fistula: clinical features and endovascular treatments. J Neurointerv Surg 2019; 11 (04) 411-415
    CrossrefPubMedGoogle Scholar
  • 45 Namba K. Vascular anatomy of the cauda equina and its implication on the vascular lesions in the caudal spinal structure. Neurol Med Chir (Tokyo) 2016; 56 (06) 310-316
    CrossrefPubMedGoogle Scholar
  • 46 Namba K, Niimi Y, Ishiguro T, Higaki A, Toma N, Komiyama M. Cauda equina and filum terminale arteriovenous fistulas: anatomic and radiographic features. AJNR Am J Neuroradiol 2020; 41 (11) 2166-2170
    CrossrefPubMedGoogle Scholar
  • 47 Giordan E, Brinjikji W, Ciceri E, Lanzino G. Arteriovenous fistulae of the filum terminale. J Neurointerv Surg 2018; 10 (02) 191-197
    CrossrefPubMedGoogle Scholar
  • 48 Djindjian M, Ribeiro A, Ortega E, Gaston A, Poirier J. The normal vascularization of the intradural filum terminale in man. Surg Radiol Anat 1988; 10 (03) 201-209
    CrossrefPubMedGoogle Scholar
  • 49 Hiramatsu M, Sugiu K, Hishikawa T. et al. Epidemiology of dural arteriovenous fistula in Japan: analysis of Japanese registry of neuroendovascular therapy (JR-NET2). Neurol Med Chir (Tokyo) 2014; 54: 63-71
    CrossrefPubMedGoogle Scholar
  • 50 Reinges MHT, Thron A, Mull M, Huffmann BC, Gilsbach JM. Dural arteriovenous fistulae at the foramen magnum. J Neurol 2001; 248 (03) 197-203
    CrossrefPubMedGoogle Scholar
  • 51 Wang JY, Molenda J, Bydon A. et al. Natural history and treatment of craniocervical junction dural arteriovenous fistulas. J Clin Neurosci 2015; 22 (11) 1701-1707
    CrossrefPubMedGoogle Scholar
  • 52 Hiramatsu M, Sugiu K, Ishiguro T. et al. Angioarchitecture of arteriovenous fistulas at the craniocervical junction: a multicenter cohort study of 54 patients. J Neurosurg 2018; 128 (06) 1839-1849
    CrossrefPubMedGoogle Scholar
  • 53 Bhattacharya JJ, Luo CB, Suh DC, Alvarez H, Rodesch G, Lasjaunias P. Wyburn-Mason or Bonnet-Dechaume-Blanc as cerebrofacial arteriovenous metameric syndromes (CAMS). A new concept and a new classification. Interv Neuroradiol 2001; 7 (01) 5-17
    CrossrefPubMedGoogle Scholar
  • 54 Etchevers HC, Vincent C, Le Douarin NM, Couly GF. The cephalic neural crest provides pericytes and smooth muscle cells to all blood vessels of the face and forebrain. Development 2001; 128 (07) 1059-1068
    CrossrefPubMedGoogle Scholar
  • 55 Rodesch G, Hurth M, Alvarez H, Tadié M, Lasjaunias P. Classification of spinal cord arteriovenous shunts: proposal for a reappraisal – the Bicêtre experience with 155 consecutive patients treated between 1981 and 1999. Neurosurgery 2002; 51 (02) 374-379 , discussion 379–380
    PubMedGoogle Scholar