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CC BY-NC-ND 4.0 · Asian J Neurosurg 2023; 18(04): 805-809
DOI: 10.1055/s-0043-1776050
Case Report

Atlantoaxial Instability with Persistent Second Intersegmental Artery

Batuk Diyora
1   Department of Neurosurgery, Lokmanya Tilak Municipal General Hospital, Sion, Mumbai, Maharashtra, India
,
Ravi Wankhade
1   Department of Neurosurgery, Lokmanya Tilak Municipal General Hospital, Sion, Mumbai, Maharashtra, India
,
Kavin Devani
1   Department of Neurosurgery, Lokmanya Tilak Municipal General Hospital, Sion, Mumbai, Maharashtra, India
,
Anup Purandare
1   Department of Neurosurgery, Lokmanya Tilak Municipal General Hospital, Sion, Mumbai, Maharashtra, India
,
Prakash Palave
1   Department of Neurosurgery, Lokmanya Tilak Municipal General Hospital, Sion, Mumbai, Maharashtra, India
,
Sagar Gawali
1   Department of Neurosurgery, Lokmanya Tilak Municipal General Hospital, Sion, Mumbai, Maharashtra, India
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Abstract

Understanding the anatomy of the vertebral artery is essential while manipulating the craniovertebral joint during surgery. Its anomalous course in congenital atlantoaxial dislocation makes it more vulnerable to injury. Preoperative dedicated computed tomography (CT) angiography helps identify the artery's position and plan for surgical procedure. A 13-year-boy presented with neck pain and spastic quadriparesis for 1 year. Radiological imaging of the craniovertebral junction revealed atlantoaxial instability with basilar invagination. His CT angiography of neck and brain vessels revealed an anomalous course of the vertebral artery due to a persistent second intersegment artery. He underwent posterior atlantoaxial fixation after mobilization of the vertebral artery. His clinical condition significantly improved after surgery. We report a case of management of an atlanto axial dislocation with persistent second intersegment artery and describe the role of vertebral artery mobilization during surgery.

Keywords

atlantoaxial instability - vertebral artery - CT angiography - 3D CT - Os odontoideum

Organization: L.T.M. Medical College and Sion General Hospital, Mumbai




Publication History

Article published online:
29 December 2023

© 2023. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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