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The Governor Vessel (GV)
Published in Narda G. Robinson, Interactive Medical Acupuncture Anatomy, 2016
Median (or Middle) sacral vein: Accompanies the median sacral artery on the ventral sacrum. The median sacral vein forms a single vein that drains either into the left common iliac vein or the junction of the two iliac veins.
Anatomical Approaches for Minimally Invasive Spine Surgery
Published in Alexander R. Vaccaro, Christopher M. Bono, Minimally Invasive Spine Surgery, 2007
Donald C. Shields, Larry T. Khoo, Grigory Goldberg, R. Vaccaro Alexander
Anatomical borders of this space anteriorly include the visceral fascia covering the posterior aspect of the mesorectum. The parietal fascia lining the sacrum and coccyx bounds the presacral space posteriorly. The anterior (pelvic) surface of the sacrum is shaped in a concave fashion in both transverse and rostrocaudal directions (21). As the sacrum is formed by the fusion of five vertebral bodies, four transverse ridges are noted along this surface with a corresponding anterior neural foramen on each side. The foraminae are oriented in a slightly anterolateral direction allowing passage for exiting anterior divisions of sacral nerves and lateral sacral arteries. Also, three symmetrical muscular attachments are noted on the anterior surface of the sacrum. The piriformis muscle group is found lateral to the ventral foraminae originating from the sacral lateral masses. The iliacus group is attached to the superior lateral aspect of the sacrum, and the coccygeus to the inferior lateral sacrum. Important vascular structures related to this approach include the median sacral artery, as discussed previously (22). This vessel lies posterior to the parietal fascia, and may descend in a variable trajectory over the sacral promontory. The vascular supply to the rectum is likewise outside of the presacral space contained within the visceral fascia covering the posterior mesorectum. Thus, the surgeon is limited to the midline in the coronal plane between the iliac vessels (mean distance of 6.4 cm) and sagittally within the presacral space with an average diameter of 1.2 cm.
A fatal and unusual iatrogenic fourth right lumbar artery injury complicating wrong-level hemilaminectomy: a case report and literature review
Published in British Journal of Neurosurgery, 2019
Francesco Ventura, Rosario Barranco, Carlo Bernabei, Lara Castelletti, Lucio Castellan
Vascular damage is most commonly related to L4-L5 and L5-S1 level laminectomy.12–14 Within these levels, the inferior vena cava is interposed between the disc and the right or common iliac arteries.12 The left common iliac artery is susceptible to injury due to its medial course and intimate relationship with the L4-L5 intervertebral disc. The aorta and inferior vena cava are subject to surgical injury at the level comprised within the second and fourth lumbar vertebrae, whereas the distal segments of the iliac vessels are exposed to any injury at the level of the fourth lumbar vertebra.15 Finally, the internal iliac veins, lumbar arteries, inferior mesenteric artery, median sacral artery and the superior rectal artery are other vessels that may also be injured during lumbar disc surgery.5,16