Vascular Anatomy of the Spinal Cord 2nd Edition PDF
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Preface
The idea for a treatise on the radiological anatomy of superficial and deep spinal cord blood vessels evolved from daily routine neuroradiological work in the early 1980s at the University of Tübingen. The topic was not induced but promoted by guest stays at hospitals in Paris, especially at the Neuroradiology Department of Lariboisière Hospital. Jean-Jacques Merland, the head of the department at that time, and his predecessor René Djindjian were highly renowned for practising selective spinal angiography at the highest level. This met very well with my long-lasting interest in diseases of the spinal cord.
Progress in selective angiography of the spinal cord in suspected disease of vascular origin demanded an advanced understanding of spinal cord blood vessel anatomy and its variations. Parallel to this development, progress in neurosurgery and especially the rapidly developing endovascular treatments in interventional neuroradiology improved our knowledge in this field and broadened the spectrum of treatment options. Significantly ameliorated disease classifications could be established, reflecting an improved understanding of pathogenetic aspects of vascular diseases like in cases of arteriovenous malformations, dural arteriovenous fistulas or vascular tumours of spine and spinal cord.
The first version of this book, Vascular Anatomy of the Spinal Cord , published in 1988, was a monograph, bearing the subtitle Neuroradiological Investigations and Clinical Syndromes . Thus, it was subdivided into an anatomical part with post-mortem examinations of arteries, capillaries and veins of the spinal cord in normal and pathological conditions and in a clinical section. The latter reflected the progress in diagnostic imaging mentioned above, mainly in selective digital subtraction angiography (DSA). Computed tomography (CT) was not very helpful for intraspinal details at that time and magnetic resonance imaging (MRI) was in its modest beginnings, at least concerning imaging of the spinal cord. Only two figures of this book from 1988 illustrate a clinical case example using MRI. Myelography using watersoluble contrast media was still the established standard technique to outline the structures within the dural sac.
The rapid technical progress in non-invasive imaging techniques in the fields of MRI, MR angiography or modern CT technologies, but also upgraded DSA units with higher spatial/ contrast resolution, offered new detailed insights into the intraspinal compartments. Consequently the diagnostic methods illustrating the clinical part of the treatise published in 1988 are only of historical value today with the exception of selective angiography. Not only for this reason, we have abstained from including this type of clinical section in this second edition. We concentrate on what we consider fundamental in this context: vascular anatomy and its correlation with spinal angiography in normal and pathological conditions.
This field of basic classical anatomy has maintained its essential importance. It has been established for a long time and has not been the subject of fast and dramatic modifications. The basic principles are generally well known, but the knowledge of details depends on whether physicians are able to make use of them for patient care or scientific purposes. But, to give an example, details about the blood vessels and the blood circulation within and around the spinal cord could be neglected to a certain degree as long as nobody was in need of this knowledge; and as long as nobody was able to perform successful diagnostic and therapeutic interventions based on this knowledge. But during the last 25 years this situation has changed substantially both for diagnostic and therapeutic modalities.
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