Vascular Anatomy of the Spinal Cord: Neuroradiological Investigations and Clinical Syndromes - Tapa dura

The idea for this treatise on the radiological anatomy of superficial and deep spinal cord vasculature evolved from daily routine neuroradiological work. This was also the reason for subdividing the monograph into a postmortem anatomical and a clinical part. The actual importance of a clear conception of radio anatomic fundamentals was made clear by many clinical conferences with neurologists, neurosurgeons and orthopedists, where a lack of knowledge about medullary syndromes of suspected vascular origin became evident. Also among neuroradiologists there is still widespread uncertainty in the interpretation of myelograms and angiographies in such cases. A study of the spinal cord's angioarchitecture is all the more justified and necessary considering the vast number of descriptions of cerebro­ vascular anatomy and pathology. The clinical challenge posed by patients suffering from partial or complete transverse spinal lesions has grown due to new diagnostic and therapeutic approaches. Myelography using water-soluble contrast media, X-ray computed tomography, magnetic resonance imaging and spinal angiography today allow and require both earlier and topographically and pathogenetically more exact classification of diseases of the spinal cord and its surrounding structures. Due to progress in microneurosurgery and interventional neuroradiology, even intramedullary lesions have become more and more accessible and treatable. Therefore this monograph mainly addresses those concerned with invasive therapeutic techniques and who are familiar with the interpretation of radio anatomic findings. A comprehensive description of medullary vascular syndromes would be beyond the scope of this treatise.

The book summarizes the anatomic guidelines of external blood supply to the spinal cord. The basic principles of arterial supply and venous drainage are illustrated by explicit schemes for quick orientation. In the first part of the book, systematic radiologic-anatomic investigations of the superficial and deep vessels of all segments of the spinal cord are introduced. The microvascular morphology is portrayed by numerous microradiographic sections in all three dimensions without overshadowing. The excellent three-dimensional representation of the vascular architecture illustrates elementary outlines and details of arterial territories, anastomotic cross-linking as well as the capillary system, particularly the hitherto unknown structure of the medullary venous system with its functionally important anastomoses and varying regional structures. These often new radiologic-anatomic findings are discussed as to their functional and pathophysiologic impact and constitute the basic on which to improve our modest understanding of vascular syndromes of the spinal cord. The neurosurgeon as well as the neuroradiologist familiar with endovascular techniques are offered information on microvascular morphology necessary for interventions at the spinal cord. The second part of the book focuses on clinical syndromes and illustrates the present diagnostic contribution of spinal angiography with special reference to the diagnosis of spinal vascular anomalies and arteriovenous malformations. Though widely underrated in the past, the pathogenetic role of the spinal venous system in direct or indirect circulatory disorders of the spinal cord is emphasized. The book fills an obvious void both from a pathologic-anatomic and a clinical point of view, and should therefore attract every physician remotely interested in neurology.