The Experts below are selected from a list of 54 Experts worldwide ranked by ideXlab platform
Marc A Huntoon - One of the best experts on this subject based on the ideXlab platform.
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the vertebral Artery is unlikely to be the sole source of vascular complications occurring during stellate ganglion block
Pain Practice, 2010Co-Authors: Marc A HuntoonAbstract:Introduction: Stellate ganglion block (SGB) is commonly performed for upper extremity complex regional pain syndrome and other conditions. Known complications of stellate block include Horner's syndrome, hoarseness, hematoma formation, airway compromise, immediate seizure (presumably from vertebral Artery injection), and death. A previous arterial anatomy study demonstrated other vessels, eg, the Ascending and deep Cervical arteries, reinforcing the blood supply of the spinal cord and brain stem. The potential role of these vessels in the pathogenesis of seizures or hematoma during SGB has not been studied. Methods: The anatomical recording log from 10 cadaver dissections and photographic records of same were reviewed to ascertain the presence of the Ascending or deep Cervical arteries, or other branches emanating from the thyroCervical or costoCervical trunk and their relationship to the medial anterior surface of the C6 and C7 transverse processes. Results: In 4 cases, as determined by the dissection log, and in 6 cases, determined by photographic images, the Ascending Cervical Artery or a branch from the thyroCervical trunk passed over the anterior aspect of the transverse processes of C6 or C7. Discussion: Arterial vessels other than the vertebral Artery that also supply the anterior spinal cord and brain stem pass directly anterior to the transverse processes at the most common sites of the SGB. It is anatomically possible, therefore, that accidental injection or induced spasm of these vessels and not the vertebral arteries is responsible for some cases of seizure, hematoma, or other vascular complications during SGB.
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anatomy of the Cervical intervertebral foramina vulnerable arteries and ischemic neurologic injuries after transforaminal epidural injections
Pain, 2005Co-Authors: Marc A HuntoonAbstract:Cervical transforaminal epidural steroid injections are performed for the treatment of radicular pain. Multiple recent case reports have raised safety concerns regarding neurologic deficits such as anterior spinal Artery syndrome and cerebellar injury after these injections. To investigate the potential causes of these injuries, an anatomic study was conducted. In this study of 10 embalmed cadavers, the Cervical intervertebral foramina were examined to determine if the Ascending or deep Cervical arteries supplied radicular or segmental medullary arteries potentially susceptible to cannulation or needle trauma during transforaminal injection. In two specimens, dissection was carried down to the spinal cord, demonstrating the anterior spinal, radicular, and segmental medullary arteries. Of 95 intervertebral foramina dissected, 21 had an arterial vessel proximal to the posterior aspect of the foraminal opening. Seven of these 21 were spinal branches that entered the foramen posteriorly, potentially forming radicular or segmental medullary vessels to the spinal cord. One additional Ascending Cervical Artery formed a segmental medullary Artery that joined the anterior spinal Artery. This would only be injured by anterior needle misplacement. Of the seven foraminal branches, three were included in the deep dissections. Two contributed to segmental medullary arteries and one to a radicular Artery. Variable anastomoses between the vertebral and Cervical arteries were found. Therefore, it is possible to introduce steroid particles into the vertebral circulation via the Cervical arteries. Critical arteries are located in the posterior aspect of the intervertebral foramen and may be vulnerable to injection or injury during transforaminal epidural steroid injection.
G Titov - One of the best experts on this subject based on the ideXlab platform.
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New concept of pathogenesis of impaired circulation in traumatic Cervical spinal cord injury and its impact on disease severity: case series of four patients
European Spine Journal, 2016Co-Authors: M Salkov, L Dzyak, A Rodinsky, Y Cherednichenko, Vitaliy Tsymbaliuk, G TitovAbstract:Purpose The purpose of this study is to justify a new concept of the pathogenesis of secondary changes in the Cervical spinal cord, and its correlation with the depth of development of neurological disorders in spinal injury. Methods Standard magnetic resonance imaging examination and angiography of the Cervical and vertebral arteries of four patients were performed to diagnose the prevalence rate of ischemia and edema, and examine the spinal cord vasculature. Correlation of the data obtained with the neurological status was performed. Results Collateral circulation is most apparent in the upper-Cervical region, above the C4 vertebra. Following occlusion of the vertebral Artery, the circulation above the C4 vertebra is performed by collaterals of the Ascending Cervical Artery. With extensive damage to the spinal cord, the intensity of edema and ischemia can be regarded as the effect of damage to radicular medullary arteries, which are injured in the intervertebral foramen. Secondary changes of the spinal cord are most apparent by impaired circulation in the Artery of Cervical enlargement. Conclusions Collateral circulation is a significant factor that limits the damage to the Cervical spinal cord. Impaired circulation in the Artery of Cervical enlargement is significant in extension of perifocal ischemia. The appearance of early arteriovenous shunting in the region of a primary spinal cord injury (contusion focus) by angiography is pathognomonic. The data obtained open a perspective for the endovascular treatment of spinal cord injury.
J. W. Jackson - One of the best experts on this subject based on the ideXlab platform.
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A complication of percutaneous cannulation of the internal jugular vein
2016Co-Authors: J. D. Wisheart, M. A. Hassan, J. W. JacksonAbstract:Reviews of the use of the technique of percutaneous cannulation of the internal jugular vein for central venous pressure monitoring have indicated that it is free from serious complications. A patient is reported here in whom the Ascending Cervical Artery was damaged during attempted cannulation of the internal jugular vein prior to aortic valve replacement. Haemorrhage from this site after the operation led initially to an extrapleural haematoma and soon afterwards to a haemothorax, which proved fatal despite immediate resuscitation and exploration. Percutaneous cannulation of the internal jugular vein is widely practised for central venous pres-sure monitoring during cardiac surgery. It was first described by English, Frew, Piggott, and Zaki (1969), who reported 200 cases without complication. Jernigan, Gardner, Mahr, and Milburn (1970) used it in 1,000 cases with three complications, all successfully treated. This report concerns a fatality arising from this technique
M Salkov - One of the best experts on this subject based on the ideXlab platform.
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New concept of pathogenesis of impaired circulation in traumatic Cervical spinal cord injury and its impact on disease severity: case series of four patients
European Spine Journal, 2016Co-Authors: M Salkov, L Dzyak, A Rodinsky, Y Cherednichenko, Vitaliy Tsymbaliuk, G TitovAbstract:Purpose The purpose of this study is to justify a new concept of the pathogenesis of secondary changes in the Cervical spinal cord, and its correlation with the depth of development of neurological disorders in spinal injury. Methods Standard magnetic resonance imaging examination and angiography of the Cervical and vertebral arteries of four patients were performed to diagnose the prevalence rate of ischemia and edema, and examine the spinal cord vasculature. Correlation of the data obtained with the neurological status was performed. Results Collateral circulation is most apparent in the upper-Cervical region, above the C4 vertebra. Following occlusion of the vertebral Artery, the circulation above the C4 vertebra is performed by collaterals of the Ascending Cervical Artery. With extensive damage to the spinal cord, the intensity of edema and ischemia can be regarded as the effect of damage to radicular medullary arteries, which are injured in the intervertebral foramen. Secondary changes of the spinal cord are most apparent by impaired circulation in the Artery of Cervical enlargement. Conclusions Collateral circulation is a significant factor that limits the damage to the Cervical spinal cord. Impaired circulation in the Artery of Cervical enlargement is significant in extension of perifocal ischemia. The appearance of early arteriovenous shunting in the region of a primary spinal cord injury (contusion focus) by angiography is pathognomonic. The data obtained open a perspective for the endovascular treatment of spinal cord injury.
J. D. Wisheart - One of the best experts on this subject based on the ideXlab platform.
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A complication of percutaneous cannulation of the internal jugular vein
2016Co-Authors: J. D. Wisheart, M. A. Hassan, J. W. JacksonAbstract:Reviews of the use of the technique of percutaneous cannulation of the internal jugular vein for central venous pressure monitoring have indicated that it is free from serious complications. A patient is reported here in whom the Ascending Cervical Artery was damaged during attempted cannulation of the internal jugular vein prior to aortic valve replacement. Haemorrhage from this site after the operation led initially to an extrapleural haematoma and soon afterwards to a haemothorax, which proved fatal despite immediate resuscitation and exploration. Percutaneous cannulation of the internal jugular vein is widely practised for central venous pres-sure monitoring during cardiac surgery. It was first described by English, Frew, Piggott, and Zaki (1969), who reported 200 cases without complication. Jernigan, Gardner, Mahr, and Milburn (1970) used it in 1,000 cases with three complications, all successfully treated. This report concerns a fatality arising from this technique
