Shiiya Haruhiko, Tanaka Akihiko, Sakuraba Motoki, Nakamura Masanori, Shibayama Yui, Tsuji Takahiro, Fukasawa Yuichiro
Department of Thoracic Surgery, Sapporo City General Hospital, Sapporo, Japan.
Kyobu Geka. 2014 May;67(5):371-4.
The thoracolumbar spinal cord receives its blood supply primarily from the artery of Adamkiewicz (AA), a branch of thoracolumbar intercostal arteries. Aortic cross-clamping during operation for descending aortic aneurysms can cause paraplegia due to spinal cord ischemia secondary to low blood flow through the AA. A 69-year-old woman was diagnosed with a left posterior mediastinal tumor measuring 66 mm. The tumor was adjacent to the thoracic aorta between Th10 to Th12 vertebral levels. Preoperative 3-dimensional computed tomography (3D-CT) imaging revealed 2 AAs originated from the 10th and 11th left intercostal arteries just near the tumor. The patient underwent a left thoracotomy and the 2 intercostal arteries were carefully dissected from the encapsulated tumor. Complete resection was safely achieved with preservation of the AAs. Pathology revealed a schwannoma. There were no complications. In performing thoracic surgery for posterior mediastinal tumors, it is important to identify the AAs preoperatively and preserve them.
胸腰段脊髓主要由Adamkiewicz动脉（AA）供血，Adamkiewicz动脉是胸腰段肋间动脉的一个分支。在降主动脉瘤手术中进行主动脉交叉钳夹时，由于通过Adamkiewicz动脉的血流减少导致脊髓缺血，可引起截瘫。一名69岁女性被诊断出患有一个直径66 mm的左后纵隔肿瘤。该肿瘤在第10至第12胸椎水平与胸主动脉相邻。术前三维计算机断层扫描（3D-CT）成像显示，2支Adamkiewicz动脉起源于肿瘤附近的第10和第11左肋间动脉。患者接受了左胸切开术，并从包裹性肿瘤中仔细分离出2支肋间动脉。在保留Adamkiewicz动脉的情况下安全地实现了完整切除。病理检查显示为神经鞘瘤。无并发症发生。在进行后纵隔肿瘤的胸外科手术时，术前识别Adamkiewicz动脉并予以保留很重要。
