PURPOSE: Magnetic resonance imaging (MRI) has been used to screen and follow-up spinal dural arteriovenous fistulae (SDAVF). The purpose of this study was to evaluate the association between MRI findings and neurologic function in SDAVF. This study also investigated clinical features and treatment results of SDAVF. MATERIALS AND METHODS: A total of 15 consecutive patients who underwent embolization or surgery for SDAVF were included. We treated seven (60%) patients with embolization and six (40%) with surgery. We analysed clinical features, MRI findings, treatment results, and neurologic function. Neurologic function was measured by the Aminoff-Logue disability scale (ALS). RESULTS: Patients with longer levels of intramedullary high signal intensity in preoperative T2-weighted images (T2WI) exhibited worse pre- and postoperative ALS scores (r=0.557, p=0.031; r=0.530, p=0.042, Pearson correlation). Preoperative ALS score was significantly correlated with postoperative ALS score (r=0.908, p=0.000, Pearson correlation). The number of levels showing intramedullary high signal intensity in T2WI decreased significantly postoperatively (5.2+/-3.1 vs. 1.0+/-1.4, p=0.001, Wilcoxon ranked test). CONCLUSION: The number of involved levels of high signal intensity in preoperative T2WI is useful for predicting pre- and postoperative neurologic function in SDAVF.
Adult ; Aged ; Angiography ; Arteriovenous Fistula/*pathology/radiography/*surgery ; Central Nervous System Vascular Malformations/*pathology/radiography/*surgery ; Embolization, Therapeutic/*methods ; Female ; Humans ; *Magnetic Resonance Imaging ; Male ; Middle Aged ; Postoperative Period ; Predictive Value of Tests ; Prognosis ; Retrospective Studies ; Severity of Illness Index ; Spinal Cord/abnormalities/*blood supply/pathology/surgery ; Treatment Outcome

PURPOSE: Magnetic resonance imaging (MRI) has been used to screen and follow-up spinal dural arteriovenous fistulae (SDAVF). The purpose of this study was to evaluate the association between MRI findings and neurologic function in SDAVF. This study also investigated clinical features and treatment results of SDAVF. MATERIALS AND METHODS: A total of 15 consecutive patients who underwent embolization or surgery for SDAVF were included. We treated seven (60%) patients with embolization and six (40%) with surgery. We analysed clinical features, MRI findings, treatment results, and neurologic function. Neurologic function was measured by the Aminoff-Logue disability scale (ALS). RESULTS: Patients with longer levels of intramedullary high signal intensity in preoperative T2-weighted images (T2WI) exhibited worse pre- and postoperative ALS scores (r=0.557, p=0.031; r=0.530, p=0.042, Pearson correlation). Preoperative ALS score was significantly correlated with postoperative ALS score (r=0.908, p=0.000, Pearson correlation). The number of levels showing intramedullary high signal intensity in T2WI decreased significantly postoperatively (5.2+/-3.1 vs. 1.0+/-1.4, p=0.001, Wilcoxon ranked test). CONCLUSION: The number of involved levels of high signal intensity in preoperative T2WI is useful for predicting pre- and postoperative neurologic function in SDAVF.
Adult ; Aged ; Angiography ; Arteriovenous Fistula/*pathology/radiography/*surgery ; Central Nervous System Vascular Malformations/*pathology/radiography/*surgery ; Embolization, Therapeutic/*methods ; Female ; Humans ; *Magnetic Resonance Imaging ; Male ; Middle Aged ; Postoperative Period ; Predictive Value of Tests ; Prognosis ; Retrospective Studies ; Severity of Illness Index ; Spinal Cord/abnormalities/*blood supply/pathology/surgery ; Treatment Outcome

OBJECTIVESTo observe the protective effect of retrograde venous perfusion of cryogenic liquid via accessory hemiazygos vein and treated with resveratrol on spinal cord injury and evaluate the expression changes of microtubule-associated protein 2 (MAP-2) after spinal cord ischemia reperfusion injury (SCII) in swine.

METHODSEighteen swine were divided into 3 groups: group I/R (n = 6, operation group), group CL (n = 6, retrograde venous perfusion of cryogenic liquid), group CL+Res (n = 6, retrograde venous perfusion of cryogenic liquid and treated with resveratrol after ischemia). In the group I/R, the aorta was clamped for 60 minutes and then removed. In the group CL and CL+Res, 9 g/L cold (4 °C) saline solution (perfusion rate, 16.65 ml/min) was infused into the accessory hemiazygos vein during ischemia.In the group CL+Res, the swine were treated with resveratrol (10 mg/kg) after spinal cord ischemia. Arterial pressure, blood gas analysis and the spinal canal and nasopharyngeal temperature changes were monitored during the surgery. Nervous function were assessed at 6 hours, 1, 2 days, 1, 2, 4 weeks and MAP-2 expression were detected at 4 weeks after reperfusion by using Western blot analysis in spinal cord tissue.

RESULTSAfter operation 18 swine were all survival. Behavioral scores of all groups decreased until 1 week after reperfusion and increased as time went by. The scores of group CL and CL+Res were higher than group I/R (F = 8.612, 17.276 and 11.985, P = 0.035,0.011 and 0.023) at 6 hours, 1, 2 days, group CL+Res were higher than group CL(P = 0.021) at 1 days after surgery. After descending aortic cross clamping, the spinal canal and nasopharyngeal temperature were obviously decreased in all groups and dropped to the lowest at 60 minutes after ischemia and 20 minutes after reperfusion in group I/R and the other groups respectively(F = 23.187-55.029, P < 0.01).In group CL(0.54 ± 0.26) and CL+Res (0.66 ± 0.31), the MAP-2 expression were higher than group I/R(0.37 ± 0.18) (F = 9.381, P = 0.037) , and the level in group CL+Res was higher than in group CL (P = 0.021) .

CONCLUSIONRetrograde venous perfusion of cryogenic liquid via accessory hemiazygos vein and treated with resveratrol can relieve the ischemia-induced spinal cord injury in swine.

Animals ; Hypothermia, Induced ; Male ; Microtubule-Associated Proteins ; metabolism ; Reperfusion Injury ; therapy ; Spinal Cord ; blood supply ; Spinal Cord Injuries ; therapy ; Stilbenes ; therapeutic use ; Swine

Heat shock protein 27 belongs to the heat shock protein family in the small molecular weight family. This review collected a number of literature to analyze the expression meaning and mechanism of HSP27,expounded HSP27 with inhibition of NO production, maintenance of cell protein stability and accelerated cell damage repair function. At the same time, HSP27 also has a resistance to apoptosis, protecting mitochondria, inhibiting activation of nuclear factor and other related functions. The heat shock protein 27 has protection in spinal cord ischemia-reperfusion.
Apoptosis ; HSP27 Heat-Shock Proteins ; physiology ; Humans ; Nitric Oxide ; biosynthesis ; Reperfusion Injury ; prevention & control ; Spinal Cord ; blood supply

Acupuncture Therapy ; Hemangioma, Cavernous ; surgery ; Humans ; Male ; Postoperative Complications ; therapy ; Spinal Cord ; blood supply ; Young Adult

OBJECTIVESTo evaluate efficacy of microsurgical hemilaminectomy approach and use of intraoperative indocyanine green videoangiography for patients with intradural dorsal arteriovenous fistula.

METHODSMedical records and follow-up data of 24 patients who were microsurgically treated at a single institution for intradural dorsal arteriovenous fistula between January 2004 and August 2008 were retrospectively reviewed. Preoperatively DSA was performed for definite diagnosis. All patients were evaluated with the Aminoff and Logue scale. Preoperative, 4 patients had excellent spinal condition having mean score of 1.0; 8 cases had good spinal condition with mean score of 3.4; 9 cases had average spinal condition with mean score of 6.9; 3 cases had poor spinal condition with mean score of 10.0. Twenty two cases had one feeder while 2 cases had two feeding arteries. All the patients underwent microsurgical hemilaminectomy via a posterior approach. Two patients received complemented surgery because of the recurrence of the lesion after embolisation failed. Three patients received intraoperative indocyanine green videoangiography. Combined followed-up imaging and myelonic function were used for evaluating followed-up data.

RESULTSMean follow up was done up to 36 months. Followed-up imaging didn't reveal any residual lesion or its recurrence. Spinal functional assessment using Aminoff and Logue scale showed 16 patients of excellent outcome and had mean score of 0.7; 4 had good outcome having mean score of 4.8; 3 was of average nature with mean score of 6.7; 1 had poor outcome with 9.0 scores. With the surgical treatment, 16 cases were cured, 6 were improved and 2 cases had no change according to synthetic curative effect.

CONCLUSIONSMicrosurgical treatment, especially the microsurgical hemilaminectomy via a posterior approach, is effective treatment intradural dorsal arteriovenous fistula. Intraoperative indocyanine green videoangiography is a simple auxiliary tool for intraoperative quality control and favorable surgical outcomes.

Adult ; Aged ; Arteriovenous Fistula ; surgery ; Female ; Follow-Up Studies ; Humans ; Male ; Microsurgery ; Middle Aged ; Retrospective Studies ; Spinal Cord ; blood supply ; Treatment Outcome ; Young Adult

OBJECTIVETo assess the changes of somatosensory evoked potentials (SEPs) during spinal cord ischemia and reperfusion injury and the value of SEP monitoring in evaluating neurological functions in this setting.

METHODSSpinal cord ischemia-reperfusion injury was induced in 28 rabbits by clamping the infrarenal aorta for 45 min, and the SEPs were monitored before and at 5, 10, and 15 min after ischemia, and at 15, 30, and 60 min and 2, 24 and 48 h after reperfusion. The neurological function score (NFS) of the rabbits was evaluated at 6, 12, 24 and 48 h after reperfusion, and the pathological changes of the spinal cord were observed 48 h after reperfusion.

RESULTSSEPs P1-wave latency significantly increased 5 min after ischemia (P<0.01) and the wave amplitude decreased 8 min after ischemia (P<0.01). SEPs disappeared 10 min after ischemia and recovered 15 min after reperfusion, but the P1-wave latency still remained longer and P1-wave amplitude lower than the measurements before ischemia (P<0.01). P1-wave amplitude became normal 15 min after the reperfusion (P>0.05), and the P1-wave latency gradually recovered 30 min after reperfusion, but still significantly longer than the preischemic value (P<0.01). P1-wave amplitude decreased again at 24 and 48 h after reperfusion (P<0.01). The NFS gradually increased at 24 and 48 h after the reperfusion (P<0.01). The changes in P1-wave amplitude at 24 and 48 h after reperfusion showed an obvious correlation to NFS (r=-0.881 and -0.925, respectively, P<0.01). Hemorrhage, swelling, and degeneration and neutrophil infiltration occurred in the spinal cord tissue 48 h after the reperfusion.

CONCLUSIONThe changes of SEP P1-wave amplitude can better reflect the spinal cord function than the wave latency during spinal cord ischemia-reperfusion injury, and SEP monitoring provides reliable evidence for prognostic evaluation of the neurological function.

Animals ; Evoked Potentials, Somatosensory ; physiology ; Female ; Ischemia ; physiopathology ; Male ; Monitoring, Physiologic ; methods ; Rabbits ; Reperfusion Injury ; physiopathology ; Spinal Cord ; blood supply

BACKGROUNDDamage to the spinal cord after the treatment of the descending thoracic and thoracoabdominal aortic aneurysms is an uncommon but devastating complication. The artery of Adamkiewicz (AKA) is the principal arterial supply of the anterior spinal artery (ASA) in the lower thoracic and lumbar level. The purpose of this study was to evaluate the visualization of the anterior spinal artery and the artery of Adamkiewicz, the affecting factors for the detection rate using multi-detector row CT (MDCT).

METHODSNinety-nine consecutive patients (31 women and 68 men; age range, 25 - 90 years; average age 61.3 years), with suspicion for thoracic aortic lesions necessitating surgical intervention (31 aortic aneurysm, 45 dissection, 5 intramural hematoma, and 18 normal), underwent CT angiography from the aortic arch to the aortic bifurcation. Transverse sections, multiplanar reformations and thin maximum intensity projections were used to assess the ASA and AKA. The level of the ASA and AKA origins and CT acquisition parameters were recorded. The contrast-to-noise ratio of the image, an index of the mass of the T11 body (vertebral mass index), the subcutaneous fat thickness, and the CT value within the aortic arch and at the T11 level were measured. The detection of the ASA and AKA were evaluated relative to the acquisition parameters, scan characteristics, and aortic lesion type. Differences were assessed with the Wilcoxon rank-sum and t tests.

RESULTSThe ASA was visualized in 51 patients (52%) and the AKA in 18 patients (18%). The ASA was identified in 36/67 patients (54%) with 1.25 mm thickness and in 15/32 patients (47%) with 2.5 - 3.0 mm thickness. This difference did not achieve significance (P = 0.13). The detection rate of the ASA and the AKA was influenced by the vertebral mass index and the contrast-to-noise ratio (P < 0.05). The amount of subcutaneous fat affected the detection rate of the ASA (P < 0.05) but not the AKA. In CT scans of ASA detection, the mean CT values in the aorta at the arch and at T11 were 360 and 358 HU, respectively, whereas in CT scans without ASA detection, the CT values in the aorta at the arch and at T11 were lower (P < 0.05), 297 and 317 HU, respectively.

CONCLUSIONSThe ASA and AKA were less frequently detected in our cohort than previous reports. The visualization of the ASA and AKA was significantly affected by aortic enhancement, the "vertebral mass index", and the contrast-to-noise ratio.

Adult ; Aged ; Aged, 80 and over ; Angiography ; methods ; Aortic Aneurysm, Thoracic ; diagnostic imaging ; pathology ; surgery ; Contrast Media ; administration & dosage ; Female ; Humans ; Iohexol ; administration & dosage ; Male ; Middle Aged ; Spinal Cord ; blood supply ; diagnostic imaging ; pathology ; Tomography, X-Ray Computed ; methods

Based on the recording of the Governor Vessel in Taisu (Commentary on Huang di's Internal Classic), deeply analyze and probe cognition and feature of the Governor Vessel in Taisu, and compare with other related literatures in Huangdi's Internal Classic and Classic on 81 Medical Problems, discovering that cognition of the Governor Vessel in Taisu is more early than the theory of the Governor Vessel handed down from ancient times, infer that the Governor Vessel recorded in Taisu possibly is early model of the theory of the Governor Vessel handed down from ancient times. Further studies discover that cognition of the Governor Vessel in Taisu is related with clinical practice of "spinal cord method", which possibly is clinical basis of origination of the Governor Vessel.
Acupuncture Points ; Blood Vessels ; History, Ancient ; Humans ; Medicine, Chinese Traditional ; history ; Spinal Cord ; blood supply

The relationship of affected regions, cause of disease, pathogenesis of flaccidity with physiological functions of the Governor Vessel is expounded, indicating that "skin, muscle, tendon, vessel and joint" are basic structures of performing motor function of the organism, which depend on nourishing of qi, blood, body fluid, essence and marrow; "insufficiency of essence and marrow" and "deficiency of qi and blood" are keys of pathogenensis of flaccidity; "deficiency or obstruction of the Governor Vessel" and "yang of the Governor Vessel unable to function" are the basis of channels and collaterals for flaccidity attack. Clinically, regulation of the Governor Vessel can promote repair of morphosis and functions of the Governor Vessel (brain and spinal cord), and rebuilding of the regulative system of the brain-the Governor Vessel (spinal cord)-viscera-channels, qi and blood functional activities, so as to restore the normal distribution and transduction of qi, blood, body liquid, essence and marrow to nourish skin, muscle, tendon, vessel and joint.
Acupuncture Therapy ; methods ; Blood Vessels ; physiology ; Brain ; blood supply ; Humans ; Medicine, Chinese Traditional ; Muscle Hypotonia ; etiology ; therapy ; Qi ; Spinal Cord ; blood supply