title: Microsurgical anatomy of the Adamkiewicz artery-anterior spinal artery junction.
abstract: OBJECTIVE
  The aim of this study is to describe the anterior spinal artery-Adamkiewicz artery (ASA-AKA) junction and establish a classification allowing defining the neurological risk in either thoracoabdominal aorta aneurysm treatment and in anterior or transforaminal thoracolumbar spine surgery.
  
  
  METHODS
  Fifteen spinal cords of fresh cadavers were dissected. Both lumbar arteries and ASA were injected with strongly diluted red-colored silicon.
  
  
  RESULTS
  The dural crossing of AKA was located on the left side in 86 % of cases, between T8 and T10 in 73.33 % of cases and L1-L2 in 26.67 % of cases. The average diameter of the ascending branch of AKA was 1.10 mm (range 0.8-1.9 mm), and its average length was 30.27 mm (range 12.3-60 mm). The AKA's arch average diameter was 11.3 mm (range 9-20 mm) with an open downward angle average of 20.1° (range 11°-30°). The descending branch of AKA which was a continuation of ASA had an average diameter of 1.33 mm (range 0.8-1.86 mm). The ASA at the top of the arch had an average diameter of 0.74 mm (range 0.2-1.77 mm). According to these findings, we have proposed a new classification with two types of junctions. The type I and its variant correlated to high neurological risk were present in 93.33 % of cases. The type II, correlated to medium or low neurological risk, was present in 6.67 % of cases.
  
  
  CONCLUSIONS
  These anatomical findings allow a planning of the neurological risk before thoracoabdominal aorta aneurysm or thoracolumbar anterior or transforaminal spine surgery.
authors.affiliation: Service de Neurochirurgie, Centre Hospitalier Universitaire d'Amiens Nord, Place Victor Pauchet, 80054, Amiens Cedex 01, France. beakloui@gmail.com.
authors.forename: Hermann Adonis
authors.initials: HA
authors.lastname: N'da
authors.affiliation: Service de Neurochirurgie, Centre Hospitalier Universitaire d'Amiens Nord, Place Victor Pauchet, 80054, Amiens Cedex 01, France.
authors.forename: Louis
authors.initials: L
authors.lastname: Chenin
authors.affiliation: Service de Neurochirurgie, Centre Hospitalier Universitaire d'Amiens Nord, Place Victor Pauchet, 80054, Amiens Cedex 01, France.
authors.forename: Cyril
authors.initials: C
authors.lastname: Capel
authors.affiliation: Laboratoire d'Anatomie et d'Organogénèse, Université de Picardie Jules Verne, 80036, Amiens Cedex 1, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Havet
authors.affiliation: Service de Neurochirurgie, Centre Hospitalier Universitaire d'Amiens Nord, Place Victor Pauchet, 80054, Amiens Cedex 01, France.|Laboratoire d'Anatomie et d'Organogénèse, Université de Picardie Jules Verne, 80036, Amiens Cedex 1, France.
authors.forename: Daniel
authors.initials: D
authors.lastname: Le Gars
authors.affiliation: Service de Neurochirurgie, Centre Hospitalier Universitaire d'Amiens Nord, Place Victor Pauchet, 80054, Amiens Cedex 01, France.|Laboratoire d'Anatomie et d'Organogénèse, Université de Picardie Jules Verne, 80036, Amiens Cedex 1, France.
authors.forename: Johann
authors.initials: J
authors.lastname: Peltier
mesh_terms: D000369:Aged, 80 and over; D063405:Anatomic Variation; D000792:Angiography; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D002102:Cadaver; D004210:Dissection; D005260:Female; D006801:Humans; D008297:Male; D008866:Microsurgery; D012307:Risk Factors; D013116:Spinal Cord / Q000098:blood supply*; D013131:Spine / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D014711:Vertebral Artery / Q000033:anatomy & histology*
keywords: Adamkiewicz artery; Anatomy; Anterior spinal artery; Anterior spinal artery–Adamkiewicz artery junction; Ischemia