Vertebral Artery Anomalies at the Craniovertebral Junction: A Case Report and Review of the Literature
20. Dezember 2013
02. Juni 2014
24. September 2014 (online)
Study Design Case report.
Objective The objective of this study was to report a case of an unstable C1 burst fracture in the setting of a vertebral artery anomaly at the craniovertebral junction.
Methods A 55-year-old man was admitted to the hospital with severe neck pain after falling approximately 15 feet and landing on his head. Computed tomography scan of the cervical spine revealed an unstable fracture of the C1 ring with magnetic resonance imaging evidence of a transverse ligament rupture as well as a congenital synchondrosis of the posterior arch of C1. He was neurologically intact. CT angiography (CTA) of the neck revealed an anomalous course of the right vertebral artery at the C1–C2 level.
Results Surgical intervention consisted of occiput–C3 fusion, thus avoiding the placement of C1 lateral mass screws and risking vertebral artery injury.
Conclusion We present a case of an unstable C1 burst fracture with an anomalous course of the right vertebral artery demonstrated by CTA. The presence of vertebral artery anomalies at the craniovertebral junction may prevent safe placement of C1 lateral mass screws and therefore influence the treatment options for upper cervical spine pathologies. To minimize the risk of vertebral artery injury, we elected to perform an occiput to C3 fusion. Thorough assessment of the vascular anatomy is recommended before operative intervention in the upper cervical spine to minimize the risk of complications.
- 1 Padget DH. The development of cranial arteries in the human embryo. Contrib Embryol 1948; 32: 207-261
- 2 Tokuda K, Miyasaka K, Abe H , et al. Anomalous atlantoaxial portions of vertebral and posterior inferior cerebellar arteries. Neuroradiology 1985; 27 (5) 410-413
- 3 Uchino A, Saito N, Watadani T , et al. Vertebral artery variations at the C1-2 level diagnosed by magnetic resonance angiography. Neuroradiology 2012; 54 (1) 19-23
- 4 Yamazaki M, Koda M, Aramomi MA, Hashimoto M, Masaki Y, Okawa A. Anomalous vertebral artery at the extraosseous and intraosseous regions of the craniovertebral junction: analysis by three-dimensional computed tomography angiography. Spine (Phila Pa 1976) 2005; 30 (21) 2452-2457
- 5 Yamazaki M, Okawa A, Hashimoto M, Aiba A, Someya Y, Koda M. Abnormal course of the vertebral artery at the craniovertebral junction in patients with Down syndrome visualized by three-dimensional CT angiography. Neuroradiology 2008; 50 (6) 485-490
- 6 Hong JT, Jang WY, Kim IS , et al. Posterior C1 stabilization using superior lateral mass as an entry point in a case with vertebral artery anomaly: technical case report. Neurosurgery 2011; 68 (1) , Suppl Operative ): 246-249 , discussion 249
- 7 Carmody MA, Martin MD, Wolfla CE. Persistent first intersegmental vertebral artery in association with type II odontoid fracture: surgical treatment utilizing a novel C1 posterior arch screw: case report. Neurosurgery 2010; 67 (1) 210-211 , discussion 211
- 8 Hudek R, Wanner G, Simmen HP, Werner CM. C1 fracture in a patient with a congenital cleft in the posterior arch: report on a failed conservative treatment. BMJ Case Rep 2013; ;2013