Transmedullary Venous Anastomoses: Anatomy and Angiographic Visualization Using Flat Panel Catheter Angiotomography

Area of Science:

• Radiology
• Neuroimaging
• Vascular Anatomy

Background:

• Flat panel catheter angiotomography (FPCA) is an advanced angiographic technique.
• It provides detailed visualization of spinal venous anatomy, analogous to cerebral angiography.
• Transmedullary venous anastomoses (TMVAs) are spinal venous structures primarily studied via postmortem analysis.

Purpose of the Study:

• To describe the FPCA appearance of TMVAs in clinical cases.
• To document previously undocumented configurations of TMVAs.
• To highlight the role of TMVAs as potential collateral pathways and differentiate them from spinal cord anomalies.

Main Methods:

• Retrospective analysis of 8 clinical cases undergoing FPCA.
• Detailed imaging review focusing on spinal venous structures.
• Comparison of imaging findings with known anatomical descriptions and pathological examples.

Main Results:

• FPCA successfully visualized various TMVA configurations: centrodorsolateral, median anteroposterior, and combined types.
• Two novel TMVA configurations were documented.
• A pathological case illustrated TMVAs functioning as collateral venous pathways.
• TMVAs were identified as normal structures requiring differentiation from intramedullary vascular malformations.

Conclusions:

• FPCA is effective in visualizing and characterizing TMVAs.
• Understanding TMVA anatomy via FPCA is essential for accurate diagnosis.
• FPCA aids in distinguishing normal TMVAs from pathological spinal cord conditions.