Transmedullary Venous Anastomoses: Anatomy and Angiographic Visualization Using Flat Panel Catheter Angiotomography

Jeffrey Ross Fellows' Journal Club, Spine

Fellows’ Journal Club

Editor’s Comment

Previously only defined by postmortem analysis, the use of flat panel catheter angiotomography allows definition of spinal cord transmedullary venous anastomoses.

Summary

Flat panel catheter angiotomography, a recently developed angiographic technique, offers a spinal equivalent to the venous phase obtained during cerebral angiography. This report of 8 clinical cases discusses the flat panel catheter angiotomography appearance of a type of spinal venous structure until now principally known through the analysis of postmortem material, transmedullary venous anastomosis. The illustrated configurations include centrodorsolateral, median anteroposterior, median anteroposterior with duplicated origin, and combined centrodorsolateral/median anteroposterior transmedullary venous anastomoses, while a pathologic example documents the potential role of transmedullary venous anastomoses as collateral venous pathways. Two of the reported configurations have not been previously documented. Transmedullary venous anastomoses are normal venous structures that need to be differentiated from spinal cord anomalies, such as intramedullary vascular malformations.

A 36-year-old woman with a perimedullary anastomosis. A, Spinal DSA, left L1 injection, posteroanterior projection, late venous phase, shows an anastomotic connection (white arrow) between the AMSV (black arrow) and the left PLSV (gray arrowhead). The exact location of this anastomosis (intramedullary-versus-perimedullary) cannot be clearly established in this projection. A lateral projection would not offer additional information because the ventrodorsal course of both types of anastomoses would appear similar. B, FPCA, left L1 injection, sagittal MIP reconstruction (thickness = 8 mm). The morphology of the anastomosis (white arrow) and its points of connection with the AMSV (black arrow) and left PLSV (gray arrowhead) are better appreciated. C, FPCA, left L1 injection, axial MIP reconstruction (thickness = 8 mm). This axial view unequivocally establishes the superficial course of the perimedullary anastomosis (small arrow) over the lateral aspect of the spinal cord, between the AMSV (black arrow) and the left PLSV (gray arrowhead). A central vein is documented within the anteromedian fissure (white arrowhead).
A 36-year-old woman with a perimedullary anastomosis. A, Spinal DSA, left L1 injection, posteroanterior projection, late venous phase, shows an anastomotic connection (white arrow) between the AMSV (black arrow) and the left PLSV (gray arrowhead). The exact location of this anastomosis (intramedullary-versus-perimedullary) cannot be clearly established in this projection. A lateral projection would not offer additional information because the ventrodorsal course of both types of anastomoses would appear similar. B, FPCA, left L1 injection, sagittal MIP reconstruction (thickness = 8 mm). The morphology of the anastomosis (white arrow) and its points of connection with the AMSV (black arrow) and left PLSV (gray arrowhead) are better appreciated. C, FPCA, left L1 injection, axial MIP reconstruction (thickness = 8 mm). This axial view unequivocally establishes the superficial course of the perimedullary anastomosis (small arrow) over the lateral aspect of the spinal cord, between the AMSV (black arrow) and the left PLSV (gray arrowhead). A central vein is documented within the anteromedian fissure (white arrowhead).

Read the full article: http://www.ajnr.org/content/36/7/1381.full

 

Transmedullary Venous Anastomoses: Anatomy and Angiographic Visualization Using Flat Panel Catheter Angiotomography
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Jeffrey Ross
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