Missing arteries and capillaries?

[Leif]

Missing arteries and capillaries in the spinal cord?

Since my spinal cord damage was due to an arterieovenous malformation I have some questions that I have been thinking of with respect to a possible cure in the future.

To be able to remove the AVM the radiologists and the neurosurgeons did perform embolization on my AVM inside my spinal cord and finally surgery. When they did embolization some of the feeders to the AVM were glued off. When the surgery was performed the rest of the AVM including feeding arteries and veins was cut out. The radiologists and the surgeon were very careful not to glue or cut blood vessels that was needed for the supply of the spinal cord, because that could lead to furthermore ischemia. All this is fine but in the process I believe (thinking load) that some of the blood vessels in my spinal cord where I have the problems had to be cut out. I’m thinking about the fistula itself and also the connecting blood vessels. Question is: Could there be any missing required blood vessel after such a procedure, and what kind of an effect will such a scenario have if say a treatment of i.e. stem cells are performed. Will this be a problem “since” blood vessels are “missing”? I don’t know if they are missing but if? Could there also be a way to stimulate blood vessels to grow back if they are missing? I’m thinking of say for regular muscles, heavy exercise will stimulate blood vessels to grow. Could there be other techniques to do this if missing? Thanks, Leif.

[Leif]

Missing arteries and capillaries in the spinal cord?

I guess the same thing can occur if the spinal cord had a trauma like an automobile accident. How does science look at the possibilities that some of the blood vessels required for a “cure” could be missing around (dura) or inside the cord itself, due to trauma or surgery?

[Sue Pendleton]

Missing arteries and capillaries in the spinal cord?

I guess the same thing can occur if the spinal cord had a trauma like an automobile accident. How does science look at the possibilities that some of the blood vessels required for a “cure” could be missing around (dura) or inside the cord itself, due to trauma or surgery?

Leif, since my injury was pure and simple ischemia (a small artery to the spinal cord somewhere between C4 and 5 quit allowing blood through) I wondered the samething. Wise later answered this for me much as the Germans did. When the body needs an artery it will find a way to grow one. Normally we find this in arteries in the legs as a person with peripheral artery disease walks a little more each day to grow new unblocked arteries. But it also happens in small areas inside without exercise. I didn't get an MRI done until I was off life support and by then, about 9 days post, a new small artery had grown under the damaged area.

Keps, I hope that explains what a spinal infarct is. Just like a heart attack or brain stroke the spine suffers strokes, rarely, and they can be bleeds or blockages just like the brain. A block that causes a stroke is referred to as a spinal infarct.

[Leif]

When the body needs an artery it will find a way to grow one.
Sue, thank you. I have read some about growing of blood vessels in muscles etc. I also know there has been studies in rats with some injuries where researchers has managed to make a grow factor for (I believe it was from bone marrow stem cells) growing blood vessels in the cord. I believe this is an option for acute spinal cord injuries.

For chronic spinal cord injuries I have a problem to understand how actually this will take place.

Scenario; if we have a situation where the cord has had some ischemia, where both axons and neurons are not present, where there is “nothing”. How is it then possible to stimulate blood vessels to grow into this area of the cord regardless of how many and types of grow factors where used? It is difficult to have blood vessels to grow into a place where there is “nothing”. I’m thinking about some of the therapies (treatment of chronics) ongoing in China, Russia and Turkey where stem cells are injected into an area where the cord is damaged and required blood vessels are not present. How is it then possible for the stem cells to become neurons and axons? Will not the injected stem cells die long before this transformation will take place? Is it not necessary that the blood vessels supplying oxygen and nutrition are there before the injected stem cells? Maybe this question is kind of like the question; what came first? The egg or the hen? Something has to be there before both things can take place?

[Wise Young]

Missing arteries and capillaries in the spinal cord?

I guess the same thing can occur if the spinal cord had a trauma like an automobile accident. How does science look at the possibilities that some of the blood vessels required for a “cure” could be missing around (dura) or inside the cord itself, due to trauma or surgery?

Leif, one does an angiogram to see the blood vessels. In general, what happens in the injured spinal cord is that there are more blood vessels at the injury after the injury than before. This is because injured tissues and inflammatory cells that invade into the injury site release angiogenesis fators that promote blood vessel growth.

Wise.

[Leif]

Thanks Wise,

This is someway good for the cord I believe. – The blood vessels are present I mean. Guess we just have to prepare for a combo stem cell implantation then.

[Wise Young]

Leif, many people often have increased MRI signals at their injury site. While early on after spinal cord injury (days), this usually indicates the presence of edema, the continuation of the increased signals at months or even years after injury may indicate the presence of microcysts (just pockets filled with fluid) or blood vessels. I was interested to note that the bone marrow stem cell transplants in the Korean study were associated with long-term presence of enhanced MRI at the transplantation site. It would be of interest to know whether the transplants increased angiogenesis at the injury site.

Wise.

[Leif]

I was interested to note that the bone marrow stem cell transplants in the Korean study were associated with long-term presence of enhanced MRI at the transplantation site. It would be of interest to know whether the transplants increased angiogenesis at the injury site.By writing that, do you think that there could be an unbalance in the angiogenesis at the injury site? If there will be an unbalance between the growth factors and the inhibitors at the injury site due to the transplants. Maybe there will be an unbalance in favour of the growth factors witch could result in problems for the transplants? Or in the favour of the inhibitors causing problems for growing of new blood vessels? And that this can be monitored by the long-term MRI they did?

[Leif]

Its interesting to know how the blood vessel growth will perform if trying to repair spinal cord injuries. I remember what the professor here in Norway dealing with my SCI told me one time; when he started as a young neurosurgeon he did understand how important and how much damage the blood vessel behaviour could do to the central nervous system, both for causing problems to the CNS and also for treatment options. He then involved himself in heavy studies of the nature of blood vessels. I guess he is right on that one. - And thank you too for your insight and explanations.

[Wise Young]

Leif,

MRI umordetects hydrogen signal. Since water is the most abundant source of hydrogen, increased MRI signal in the tissue is usually indicative of increased water content. Increased water content can result from several causes. If it is during the acute phase of injury, increased water content is usually deal to edema (increased water content in the tissue). In chronic injury, it may mean greater extracellular space which can also be due to increased vascular space. Edematous or vascular tissues usually have increased MRI signals.

Angiogenesis occurs in all tissues after injury. It also occurs in tumor cells. In the central nervous system, angiogenesis is always associated with glial proliferation. This is one of the reasons why I am so skeptical of the notion that glial proliferation (or glial scarring) is necessarily bad for regeneration. It is necessary for the repair of central nervous system tissues. Glial cells line the blood vessels and are responsible for the creation of the blood brain barrier. The endfeet of glia (astrocytes) form tight junctions with each other so that all molecules must pass through the glial cells before it gets into the brain or spinal cord.

Wise.

[sbdspray]

I was just embolized, no surgery. I think that since I'd been mis-diagnosed and paralyzed for 4 weeks, the radiologist just completely shut down all blood flow to the LumboSacral spinal cord. This would explain the 0% recovery i experienced. No doctor is going to want to do anything with someone with a AVM, it's seen as more of a terminal illness than a regular SCI.

[sbdspray]

If my anterior spinal artery flowed directly into the draining veins due to a type 4 anterior, on the surface, spinal avm, would this be considered infarction, since the blood flow to the spinal artery isn't blocked?
what's the difference anyway, I'm screwed for life

[Leif]

I was just embolized, no surgery. I think that since I'd been mis-diagnosed and paralyzed for 4 weeks, the radiologist just completely shut down all blood flow to the LumboSacral spinal cord. This would explain the 0% recovery i experienced. No doctor is going to want to do anything with someone with a AVM, it's seen as more of a terminal illness than a regular SCI.Sherman. Sorry to hear about the miss-diagnosing. That is way it is so important that just real qualified radiologists and surgeons should deal with AVM’s. But then again when they miss-diagnoses it, my statement can be difficult to follow. I have also read about miss-treatments where important feeders have been glued off that should not have been touched. I went all over the world to deal with mine over a period of a couple of years (you can read about it on the web link on my public profile). I had a "Diffuse (meaning it goes over several vertebra segments) Intramedullary AVM"; this is also referred to as a type AVM type II (2). It was located both in the white and grey mater. I believe I was lucky after all, they managed at the end to remove it and stop the downhill trend. After my surgery I have had some improvement with motor signals, sensation is more or less the same. Your question in your second post I don’t quite understand – hopefully Wise will comment. Leif

[Sue Pendleton]

If my anterior spinal artery flowed directly into the draining veins due to a type 4 anterior, on the surface, spinal avm, would this be considered infarction, since the blood flow to the spinal artery isn't blocked?
what's the difference anyway, I'm screwed for life

An infarct is when blood is not getting to the cord brain, bone, etc. Ischemia comes from a lack of oxygen in the effected area from whatever cause. So if you have an AVM that directly sends blood from your main anterior spinal artery (artery of Adamokowietz? Wise? help! :thinking: ) to a vein and none of the oxygen (the artery)it carries gets to the cord then, yes, in so many words, you technically have ischemia of the cord.

Also for Wise, I know the Gamma Knife is used for AVMs of the brain. Is this also used commonly in the spinal cord?

[Leif]

Gamma knife can also be used to deal with AVM’s in the spinal cord.


Although it was first designed for the brain.

Gamma Knife and later also Cyberknife radiosurgery is a relatively new radiation therapy technique used to treat small to medium sized tumors, epilepsy, trigeminal neuralgia, and abnormal blood vessel formations located deep in the brain.

Radiosurgery is a medical procedure which allows non-invasive (http://en.wikipedia.org/wiki/Non-invasive_%28medical%29) brain surgery (http://en.wikipedia.org/wiki/Neurosurgery), i.e., without actually opening the skull (http://en.wikipedia.org/wiki/Skull), by means of directed beams of ionizing radiation (http://en.wikipedia.org/wiki/Ionizing_radiation). It is a relatively recent technique (1951 (http://en.wikipedia.org/wiki/1951)), which is used to destroy, by means of a precise dosage of radiation, intracranial tumors (http://en.wikipedia.org/wiki/Tumors) and other lesions that could be otherwise inaccessible or inadequate for open surgery. There are many nervous diseases (http://en.wikipedia.org/wiki/List_of_neurological_disorders) for which conventional surgical treatment is difficult or has many deleterious consequences for the patient, due to arteries (http://en.wikipedia.org/wiki/Arteries), nerves (http://en.wikipedia.org/wiki/Nerves), and other vital structures being damaged.


The Gamma Knife offers a less invasive option for patients with a variety of neurological disorders, such as arteriovenous malformations (AVMs), acoustic neuromas, and other benign or malignant brain tumors.

In 1949, Swedish physician and neurosurgery professor Lars Leksell introduced his center of arc principle. He believed that a lesion deep within the brain could be reached by sending x-ray beams to it from any point around the skull. The radiation would not harm brain tissue until the arcs intersected at the targeted point. The process would destroy deep-seated brain lesions without opening the skull or using a scalpel, thereby eliminating the surgical risks of infection or hemorrhage.


Gamma Knife surgery is recognized worldwide as the preferred treatment for metastatic brain tumors and has successfully treated primary brain tumors and arteriovenous malformations.

The CyberKnife was developed much later than the Gamma Knife, in the 1990s, and only obtained FDA approval in 1999. This device uses a robotic arm and treats areas within the brain and other sites of the body.

Below is a comparison of the two technologies:

Gamma Knife vs Cyberknife

Developed specifically for the brain - Developed for full-body use

Single treatment - More than one treatment required

Movement restricted during treatment - Movement unrestricted; any movement requires replanning

No markers are implanted - Fiduscal markers are required for extracranial surgery; markers are prone to migration

Outcomes research began in the 1960s - Outcomes research began in the 1990s
*********

Many Universities and hospitals are using the procedures world wide. Here are two that I in some way have been in contact with. Which uses it for AVM’s in spinal cords.

Barrows Neurological Institute in Phoenix Dr. Robert F. Spetzler
Stanford University Hospital Dr. John Adler

Also a couple of links I used for this information;
http://en.wikipedia.org/wiki/Gamma_knife (http://en.wikipedia.org/wiki/Gamma_knife)
http://www.stdavidsmc.com/CustomPage.asp?guidCustomContentID={A5A35A38-2C11-4368-9AD2-E513A45A5889 (http://www.stdavidsmc.com/CustomPage.asp?guidCustomContentID={A5A35A38-2C11-4368-9AD2-E513A45A5889)

Leif