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DOI: 10.1055/s-0043-1776050
Atlantoaxial Instability with Persistent Second Intersegmental Artery
Authors
Funding None.
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.
Organization: L.T.M. Medical College and Sion General Hospital, Mumbai
Publikationsverlauf
Artikel online veröffentlicht:
29. Dezember 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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References
- 1 Lopez AJ, Scheer JK, Leibl KE, Smith ZA, Dlouhy BJ, Dahdaleh NS. Anatomy and biomechanics of the craniovertebral junction. Neurosurg Focus 2015; 38 (04) E2
- 2 Srivastava SK, Raj A, Bhosale S, Purohit S, Marathe N, Gaddikeri M. Management of congenital craniovertebral anomalies: a single-centre experience of 71 cases by an algorithmic approach. Eur Spine J 2020; 29 (11) 2758-2768
- 3 Chandra PS, Prabhu M, Goyal N, Garg A, Chauhan A, Sharma BS. Distraction, compression, extension, and reduction combined with joint remodeling and extra-articular distraction: description of 2 new modifications for its application in basilar invagination and atlantoaxial dislocation: a prospective study in 79 cases. Neurosurgery 2015; 77 (01) 67-80 , discussion 80
- 4 Salunke P, Futane S, Sahoo SK, Ghuman MS, Khandelwal N. Operative nuances to safeguard anomalous vertebral artery without compromising the surgery for congenital atlantoaxial dislocation: untying a tough knot between vessel and bone. J Neurosurg Spine 2014; 20 (01) 5-10
- 5 Sai Kiran NA, Vidyasagar K, Sivaraju L. et al. Outcome of surgery for congenital craniovertebral junction anomalies with atlanto axial dislocation/ basilar invagination: a retrospective study of 94 patients. World Neurosurg 2021; 146: e313-e322
- 6 Park JH, Kim JM, Roh JK. JH. Hypoplastic vertebral artery: frequency and associations with ischaemic stroke territory. J Neurol Neurosurg Psychiatry 2007; 78 (09) 954-958
- 7 Baik J, Baek HJ, Shin HS, Choi KH. Duplication of the right vertebral artery: MRA findings and review of the literature. Springerplus 2016; 5 (01) 1123
- 8 Ozpinar A, Magill ST, Davies JM, McDermott MW. Vertebral artery fenestration. Cureus 2015; 7 (01) e245
- 9 Yuan SM. Aberrant origin of vertebral artery and its clinical implications. Rev Bras Cir Cardiovasc 2016; 31 (01) 52-59
- 10 Maughan PH, Ducruet AF, Elhadi AM. et al. Multimodality management of vertebral artery injury sustained during cervical or craniocervical surgery. Neurosurgery 2013; 73 (2, Suppl Operative): ons271-ons281 , discussion ons281–ons282
- 11 Schroeder GD, Hsu WK. Vertebral artery injuries in cervical spine surgery. Surg Neurol Int 2013; 4 (Suppl. 05) S362-S367
- 12 Goel A, Jankharia B, Shah A, Sathe P. Three-dimensional models: an emerging investigational revolution for craniovertebral junction surgery. J Neurosurg Spine 2016; 25 (06) 740-744
- 13 Bavinck JN, Weaver DD. Subclavian artery supply disruption sequence: hypothesis of a vascular etiology for Poland, Klippel-Feil, and Möbius anomalies. Am J Med Genet 1986; 23 (04) 903-918
- 14 Salunke P. “Fusing the appropriate” in complex craniovertebral junction anomalies. Neurol India 2018; 66 (01) 151-152
- 15 Salunke P, Sahoo SK, Sood S, Mukherjee KK, Gupta SK. Focusing on the delayed complications of fusing occipital squama to cervical spine for stabilization of congenital atlantoaxial dislocation and basilar invagination. Clin Neurol Neurosurg 2016; 145: 19-27