脊髄血管解剖と血管撮影の基礎 - UMIN

1 Basics of spinal vascular anatomy and spinal angiography . Takeshi ASANO. Department of neurosurgery, Hokkaido University Key words: Spinal angiography, Vascular anatomy . gold standard modality . modality . 3-D CTA CE-MRA . modality . 1.. 31 ventral longitudinal ar- tery ventral longitudinal artery .. fig1). Fig. 1.. (fig 2,3). Fig. 2. 1-a.. : .. 1-2 .. 4 .. (1) . (a) . (b) . (2) . (a) .. (b) .. (c) .. (1) radicular artery .. (1) (radiculopial artery) .. Fig. 3. (2) (radiculomedullary artery) .. Adam-kiewicz (artery of the lumbar enlargement) . 75% T9-12 .. 1. (anterior spinal artery) .. 2. (posterior spinal artery) pial network .. (pial network, vasa corona, pial arterial plexus).

2 Lateral spinal ar- tery radial perforating artery . Fig. 4. -Intrinsic Arterial Supply (1) (sulcal artery, central sulcal artery, sulcocommissure artery) : perforating artery. 2/3 3/4 80 200 m . 1cm . 1-10 . ( ) . (2) (radial perforating artery) . (fig 5) . Fig. 5.. (pial network, vasa corona, pial arterial plexus) .. (fig 5) . (arterial basket, caudal anastomotic loop, cruciate anastomosis) . W (fig 6a-c) .. (fig2,7) . (fig 2,3) . fig . Fig. 6a,b,c Fig. 7 Fig. 8. Fig. 9a,b 1-b. (fig ). (radial perforating vein) (anterior and posterior sulcal vein) . (transmedullary anastomosis).. (1) (pial venous plexus, coronary venous plexus) .. (2) (anterior and posterior spinal vein).

3 (anterior and posterior radicular vein). 60% .. 1cm .. Fig. 10. Fig. 11 Fig. 12.. (anterior internal venous plexus). (retrocorporeal vein) (intervertebral vein) . (external vertebral venous plexus) .. 1.. a.. fig 13ab . Fig. 13a,b b.. (fig 14a) fig 14b .. fig 14ab . Fig. 14a,b c.. (fig15) .. 10 fig15 . c.. (fig 9ab) . 2.. 3. or .. motion . capacity follow up 40 .. 1.. 2.. 4.. 4F HS-1 or HS-2 .. , Cobra, Mikaelson, AL- 1 (fig 16) .. aorta . aorta . miss match .. Fig. 16. wedge .. CTA axial image . high flow Renegade Hi-Flo . 1. wedge position . 2.. spinal branch reflux . 3.. 5. Power injector ? .. subintimal injection power injector ( AVM 3-D AG ) high flow Power injector 1ml/sec, total 2-3ml.

4 6. ? ? .. 7.. feeder shunt . flow control 1 flame/sec pedicle 3 flame/sec . SDAVF low flow . 22 . high flow shunt nidus type fistula type (6 flame/sec ) . 3-D AG . (fig 17 a-c) . 8.. (20mg/ or ) ( ) .. cobra . Simmons . catheterization . Fig. 17a,b,c Fig. 18a,b,c . modality MRI MRA . DSA(3-D DSA ) CT . CTA(MPR) . DSA .. 64 CT AV . SDAVF feeder . (fig18 abc) CTA CTA .. A, Lasjaunias P, Ter Brugge : Surgical Neuro-angigraphy Vol1. Springer-Verlag, New York, 2001. A : Vascular Anatomy of the Spinal Cord. Springer-Verlag, New York, 1988. 3. Lawrence et al: Head and Neuroanatomy (Thieme Atlas of Anatomy Series). Thieme Medical Pub, 2007. 4. Barrow DL, Awad IA et al: Spinal Vascular Malformations.

5 AANS publications committee, 1999. 5. Nieuwenhuys R, Voogd J, Van Huijzen, C: The Human Central Nervous System - A Synopsis and Atlas. Springer-Verlag, Berlin, 1988. 6. ( ): . ,1997. 7. , , 2007. 8. ( ) Do's and Don'ts 9.. ,1979. 10.. , 1999. 2,3,4,6ab,10 1 . 5,12 3 . 1,11 5.