Letter: Three-Dimensional Evaluation and Classification of the Anatomy Variations of Vertebral Artery at the Craniovertebral Junction in 120 Patients of Basilar Invagination and Atlas Occipitalization

Study Design: Prospective study.Purpose: To evaluate the utility and limitations of using three-dimensional (3D)-printed models for the management of craniovertebral (CV) junction abnormalities.Overview of Literature: In comparison to other bony and vascular anomalies, CV junction abnormalities are difficult to treat. For cases of irreducible atlantoaxial dislocation (AAD), posterior reduction and stabilization have replaced anterior decompression as the standard management protocol. The use of 3D models, such as those described herein, can provide surgeons with in-depth knowledge of the vertebral artery course and bony anomalies associated with CV junction abnormalities.Methods: Clinical and radiological features of 18 patients with CV junction abnormalities were analyzed between March 2017 and February 2019 at Sawai Man Singh Medical College, Jaipur, India. Dynamic computed tomography (CT) of the CV junction and CT angiographies of the neck with respect to the vertebral artery course at the C1–C2 joints were obtained and studied. Customized 3D models of the CV junction were then made based on the CT data, and rehearsal of the surgical procedure was performed using the 3D model one day prior to performing the actual procedure.Results: Seventeen patients had congenital-type AAD, whereas one patient had posttraumatic AAD. Improvements in neck pain and myelopathy were seen in all patients at the follow-up, as analyzed using the Visual Analog Scale and the Japanese Orthopedic Association Scale score, respectively. There were no cases of malpositioning of screws or any direct vertebral artery injury, although in one patient, the distal flow in the dominant vertebral artery was cut off as it got compressed between the bony arch and the screw head.Conclusions: Compared to computer-generated images, 3D-printed models are a more practical approach for dealing with complex CV junction abnormalities. They provide surgeons with deep insights into the complex bony anomalies as well as variations in the vertebral artery courses, thereby improving surgical outcomes.

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Computed tomographic angiography to analyze dangerous vertebral artery anomalies at the craniovertebral junction in patients with basilar invagination

Clinical Neurology and Neurosurgery ◽

10.1016/j.clineuro.2020.106309 ◽

2021 ◽

Vol 200 ◽

pp. 106309

Author(s):

Chunhai Su ◽

Zan Chen ◽

Hao Wu ◽

Fengzeng Jian

Keyword(s):

Vertebral Artery ◽

Craniovertebral Junction ◽

Basilar Invagination ◽

Computed Tomographic Angiography ◽

Computed Tomographic ◽

Tomographic Angiography

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Posterior inferior cerebellar artery with an extradural origin from the V3 segment: higher incidence on the nondominant vertebral artery

Journal of Neurosurgery Spine ◽

10.3171/2017.5.spine161286 ◽

2018 ◽

Vol 28 (2) ◽

pp. 154-159 ◽

Cited By ~ 3

Author(s):

Taiki Isaji ◽

Muneyoshi Yasuda ◽

Reo Kawaguchi ◽

Masahiro Aoyama ◽

Aichi Niwa ◽

...

Keyword(s):

Vertebral Artery ◽

Posterior Inferior Cerebellar Artery ◽

Three Dimensional ◽

Ct Scanning ◽

Anatomical Variations ◽

Craniovertebral Junction ◽

Ponticulus Posticus ◽

Cerebellar Artery ◽

3D Ct Angiography ◽

Relationship Of

OBJECTIVEThe posterior inferior cerebellar artery (PICA) and the vertebral artery (VA) often exhibit anatomical variations at the craniovertebral junction (CVJ). An example of this is the PICA originating extradurally from the V3 segment of the VA. To date, some cadaveric investigations have been reported, but the incidence and relationship of this variation to the VA and the atlas as observed on clinical imaging have not been discussed. This study evaluated the prevalence of PICAs originating from the V3 on CT scanning. Other variations of the atlas and VA were also analyzed.METHODSCT images from a series of 153 patients who underwent 3D CT angiography (CTA) were analyzed, and variations of the PICA, VA, and atlas were investigated.RESULTSA total of 142 patients (284 sides) were analyzed; 11 patients (7.2%) were excluded due to poor image quality. The most common VA variation was the PICA originating from V3 (9.5% of 284 sides), which was more frequently observed on the nondominant VA than the dominant VA (22.5% vs 6.25%, p = 0.0005). A VA with a PICA end was identified in 4 sides (1.4%), which is the same incidence as observed in the persistent first intersegmental VA (1.4%). VA fenestration was only found in 1 side (0.35%). Regarding the atlas, ponticulus posticus was observed in 24 sides (8.5%). There was no relationship between the incidence of ponticulus posticus and the variations of the VA.CONCLUSIONSA PICA originating from V3 was the most common VA variation at the CVJ and was more common on the nondominant VA. Three-dimensional CTA is useful for the evaluation of this variance. Surgeons should be mindful of this variation during operations.

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Three-dimensional computed tomography angiographic study of the vertebral artery in patients with congenital craniovertebral junction anomalies

European Spine Journal ◽

10.1007/s00586-016-4580-7 ◽

2016 ◽

Vol 26 (4) ◽

pp. 1028-1038 ◽

Cited By ~ 19

Author(s):

Laxminadh Sivaraju ◽

Sunithi Mani ◽

Krishna Prabhu ◽

Roy Thomas Daniel ◽

Ari George Chacko

Keyword(s):

Computed Tomography ◽

Vertebral Artery ◽

Three Dimensional ◽

Craniovertebral Junction ◽

Angiographic Study

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Rotational vertebral artery occlusion from occipital bone anomaly: a rare cause of embolic stroke

Journal of Neurosurgery ◽

10.3171/jns.2002.97.6.1456 ◽

2002 ◽

Vol 97 (6) ◽

pp. 1456-1459 ◽

Cited By ~ 32

Author(s):

Teiji Tominaga ◽

Toshiyuki Takahashi ◽

Hiroaki Shimizu ◽

Takashi Yoshimoto

Keyword(s):

Vertebral Artery ◽

Three Dimensional ◽

Craniovertebral Junction ◽

Artery Occlusion ◽

Occipital Bone ◽

Atlantoaxial Instability ◽

Posterior Arch ◽

Content Type ◽

The Right ◽

Fine Print

✓ Vertebral artery (VA) occlusion by rotation of the head is uncommon, but can result from mechanical compression of the artery, trauma, or atlantoaxial instability. Occipital bone anomalies rarely cause rotational VA occlusion, and patients with nontraumatic intermittent occlusion of the VA usually present with compromised vertebrobasilar flow. A 34-year-old man suffered three embolic strokes in the vertebrobasilar system within 2 months. Magnetic resonance imaging demonstrated multiple infarcts in the vertebrobasilar territory. Angiography performed immediately after the third attack displayed an embolus in the right posterior cerebral artery. Radiographic and three-dimensional computerized tomography bone images exhibited an anomalous osseous process of the occipital bone projecting to the posterior arch of the atlas. Dynamic angiography indicated complete occlusion of the left VA between the osseous process and the posterior arch while the patient's head was turned to the right. Surgical decompression of the VA resulted in complete resolution of rotational occlusion of the artery. An occipital bone anomaly can cause rotational VA occlusion at the craniovertebral junction in patients who present with repeated embolic strokes resulting from injury to the arterial wall.

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Anomalous vertebral artery at the craniovertebral junction in a patient with Down syndrome

Journal of Neurosurgery Spine ◽

10.3171/spi.2004.1.3.0338 ◽

2004 ◽

Vol 1 (3) ◽

pp. 338-341 ◽

Cited By ~ 22

Author(s):

Masashi Yamazaki ◽

Masao Koda ◽

Minori Yoneda ◽

Atsuomi Aiba ◽

Hideshige Moriya

Keyword(s):

Down Syndrome ◽

Vertebral Artery ◽

Ct Angiography ◽

Three Dimensional ◽

Odontoid Process ◽

Craniovertebral Junction ◽

Transverse Foramen ◽

Content Type ◽

Ossiculum Terminale ◽

The Right

✓ The authors report a case of a patient with Down syndrome in whom the abnormal course of the right vertebral artery (VA) at the craniovertebral junction (CVJ) was accurately demonstrated on three-dimensional (3D) computerized tomography (CT) angiography. The patient was a 5-year-old boy, who developed severe myelopathy. Bone abnormalities were also present at the CVJ, including atlantoaxial and occipitoatlantal instabilities, a hypoplastic odontoid process, and ossiculum terminale. Three-dimensional CT angiography revealed that the right VA was duplicated after emerging from the C-2 transverse foramen. One half of the duplication, an artery that was as large as the left VA, turned posteromedially and entered the spinal canal between C-1 and C-2. The other half, a very small artery, ran as usual and passed through the C-1 transverse foramen. The authors performed an occipitocervical posterior fusion and a C-1 laminectomy. Intraoperatively the course of the anomalous VA was identified on Doppler ultrasonography, and the surgical approach and bone excision were undertaken carefully to avoid VA injury. Postoperatively, resolution of myelopathy was marked. In the surgical treatment of patients with Down syndrome, surgeons should consider the possibility that a VA anomaly is present at the CVJ. With preoperative 3D CT angiography, the anomalous VA can be identified precisely and the possible risk of intraoperative VA injury predetermined.

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Phonetic iconicity in the evaluative morphology of a sample of Indo-European, Niger-Congo and Austronesian languages

WORD Structure ◽

10.3366/word.2010.0003 ◽

2010 ◽

Vol 3 (2) ◽

pp. 156-180 ◽

Cited By ~ 3

Author(s):

Renáta Gregová ◽

Lívia Körtvélyessy ◽

Július Zimmermann

Keyword(s):

Three Dimensional ◽

Sound Symbolism ◽

Three Dimensional Model ◽

Austronesian Languages ◽

Place Of Articulation ◽

European Languages ◽

Phonetic Symbolism ◽

The Individual ◽

Core Vocabulary

Universals Archive (Universal #1926) indicates a universal tendency for sound symbolism in reference to the expression of diminutives and augmentatives. The research ( Štekauer et al. 2009 ) carried out on European languages has not proved the tendency at all. Therefore, our research was extended to cover three language families – Indo-European, Niger-Congo and Austronesian. A three-step analysis examining different aspects of phonetic symbolism was carried out on a core vocabulary of 35 lexical items. A research sample was selected out of 60 languages. The evaluative markers were analyzed according to both phonetic classification of vowels and consonants and Ultan's and Niewenhuis' conclusions on the dominance of palatal and post-alveolar consonants in diminutive markers. Finally, the data obtained in our sample languages was evaluated by means of a three-dimensional model illustrating the place of articulation of the individual segments.

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