Anomalous Vertebral Artery in Craniovertebral Junction With Occipitalization of the Atlas

Spine ◽  
2009 ◽  
Vol 34 (26) ◽  
pp. 2838-2842 ◽  
Author(s):  
Shenglin Wang ◽  
Chao Wang ◽  
Yi Liu ◽  
Ming Yan ◽  
Haitao Zhou
Keyword(s):  
Vertebral Artery ◽  
Craniovertebral Junction

Operative nuances to safeguard anomalous vertebral artery without compromising the surgery for congenital atlantoaxial dislocation: untying a tough knot between vessel and bone

2014 ◽  
Vol 20 (1) ◽  
pp. 5-10 ◽  
Author(s):  
Pravin Salunke ◽  
Sameer Futane ◽  
Sushant K. Sahoo ◽  
Mandeep S. Ghuman ◽  
Niranjan Khandelwal
Keyword(s):  
Vertebral Artery ◽  
Preoperative Evaluation ◽  
Posterior Inferior Cerebellar Artery ◽  
Vascular Anatomy ◽  
Craniovertebral Junction ◽  
Atlantoaxial Dislocation ◽  
Lateral Mass ◽  
3D Ct ◽  
Ct Angiogram ◽  
Pars Interarticularis

Object Stabilization of the craniovertebral junction (CVJ) by using lateral masses requires extensive dissection. The vertebral artery (VA) is commonly anomalous in patients with congenital CVJ anomaly. Such a vessel is likely to be injured during dissection or screw placement. In this study the authors discuss the importance of preoperative evaluation and certain intraoperative steps that reduce the chances of injury to such vessels. Methods A 3D CT angiogram was obtained in 15 consecutive patients undergoing surgery for congenital atlantoaxial dislocation. The course of the VA and its relationship to the C1–2 facets was studied in these patients. The anomalous VA was exposed intraoperatively, facet surfaces were drilled in all, and the screws were placed according to the disposition of the vessel. Results A skeletal anomaly was found in all 10 patients who had an anomalous VA. Four types of variations were noted: 1) the first intersegmental artery in 5 patients (bilateral in 1); 2) fenestration of VA in 1 patient; 3) anomalous posterior inferior cerebellar artery crossing the C1–2 joint in 1 patient; and 4) medial loop of VA in 5 patients. The anomalous vessel was dissected and the facet surfaces were drilled in all. The C-1 lateral mass screw was placed under vision, taking care not to compromise the anomalous vessel, although occipital screws or sublaminar wires were used in the initial cases. A medial loop of the VA necessitated placement of transpedicular or C-2 lateral mass screws instead of pars interarticularis screws. The anomalous vessel was injured in none. Conclusions Preoperative 3D CT angiography is a highly useful method of imaging the artery in patients with CVJ anomaly. It helps in identifying the anomalous VA or its branch and its relationship to the C1–2 facets. The normal side should be surgically treated and distracted first because this helps in opening the abnormal side, aiding in dissection. In the posterior approach the C-2 nerve root is always encountered before the anomalous vessel. The defined vascular anatomy helps in choosing the type of screw. The vessel should be mobilized so as to aid the drilling of facets and the placement of screws and spacers under vision, avoiding its injury (direct or indirect) or compression. With these steps, C1–2 (short segment) rigid fusion can be achieved despite the presence of anomalous VA.

Abnormal course of the vertebral artery at the craniovertebral junction in patients with Down syndrome visualized by three-dimensional CT angiography

2008 ◽  
Vol 50 (6) ◽  
pp. 485-490 ◽  
Author(s):  
Masashi Yamazaki ◽  
Akihiko Okawa ◽  
Mitsuhiro Hashimoto ◽  
Atsuomi Aiba ◽  
Yukio Someya ◽  
...  
Keyword(s):  
Down Syndrome ◽  
Vertebral Artery ◽  
Ct Angiography ◽  
Three Dimensional ◽  
Craniovertebral Junction

scholarly journals C3 segmental vertebral artery and its surgical implication in craniovertebral junction anomalies: Insights from two cases

2021 ◽  
Vol 12 (1) ◽  
pp. 81
Author(s):  
KuntalKanti Das ◽  
Suyash Singh ◽  
Kamlesh Rangari ◽  
Deepak Khatri ◽  
Priyadarshi Dikshit ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Craniovertebral Junction

Comparison of the Far Lateral and Extreme Lateral Variants of the Atlanto-occipital Transarticular Approach to Anterior Extradural Lesions of the Craniovertebral Junction

Neurosurgery ◽  
2003 ◽  
Vol 53 (3) ◽  
pp. 662-675 ◽  
Author(s):  
Masatou Kawashima ◽  
Necmettin Tanriover ◽  
Albert L. Rhoton ◽  
Arthur J. Ulm ◽  
Toshio Matsushima
Keyword(s):  
Vertebral Artery ◽  
Anterior Part ◽  
Cerebrospinal Fluid Leak ◽  
Craniovertebral Junction ◽  
Lateral Approach ◽  
Sternocleidomastoid Muscle ◽  
Transoral Approach ◽  
Microsurgical Anatomy ◽  
Far Lateral Approach ◽  
Far Lateral

Abstract OBJECTIVE Managing lesions situated in the anterior aspect of the craniovertebral junction (CVJ) remains a challenging neurosurgical problem. The purposes of this study were to examine the microsurgical anatomy of the anterior extradural aspect of the CVJ and the differences in the exposure obtained by the far lateral and extreme lateral atlanto-occipital transarticular approaches. The far lateral approach, as originally described, is a lateral suboccipital approach directed behind the sternocleidomastoid muscle and the vertebral artery and just medial to the occipital and atlantal condyles and the atlanto-occipital joint. The extreme lateral approach, as originally described, is a direct lateral approach deep to the anterior part of the sternocleidomastoid muscle and behind the internal jugular vein along the front of the vertebral artery. Both approaches permit drilling of the condyles at the atlanto-occipital joint but provide a different exposure because of the differences in the direction of the approach. METHODS Fifteen adult cadaveric specimens were studied using a magnification of ×3 to ×40 after perfusion of the arteries and veins with colored silicone. The microsurgical anatomy of the extradural aspects of the CVJ and the two atlanto-occipital transarticular approaches were examined in stepwise dissections. RESULTS The far lateral atlanto-occipital transarticular approach provides excellent exposure of the extradural lesions located in the ipsilateral anterior and anterolateral aspects of the extradural region of the CVJ. The extreme lateral atlanto-occipital transarticular approach provides excellent exposure, not only on the side of the exposure, but also extending across the midline to the medial aspect of the contralateral atlanto-occipital joint and the lower clivus. CONCLUSION The far lateral and extreme lateral variants of the atlanto-occipital transarticular approach provide an alternative to the transoral approach to the anterior extradural structures at the CVJ. Compared with the transoral approach, both approaches provide a shorter operative route, avoid the contaminated nasopharynx, reduce the incidence of cerebrospinal fluid leak, and are not limited laterally by the atlanto-occipital joint.

scholarly journals Unilateral extended suboccipital approach for a C1 dumbbell schwanoma

2015 ◽  
Vol 22 (1) ◽  
pp. 38-42
Author(s):  
R.M. Gorgan ◽  
Angela Neacşu ◽  
A. Giovani
Keyword(s):  
Vertebral Artery ◽  
Fibrous Tissue ◽  
Cranial Nerves ◽  
Gain Control ◽  
Complete Removal ◽  
Craniovertebral Junction ◽  
Lateral Approach ◽  
Far Lateral Approach ◽  
Far Lateral ◽  
Lower Cranial Nerves

Abstract Craniovertebral junction tumors represent a complex pathology carrying a high risk of injuring the vertebral artery and the lower cranial nerves. Dumbbell C1- C2 schannomas are very rare tumors in this location. We present a case of a 66 years old male accepted for left laterocervical localized pain, headache and vertigo, with a large C1 dumbbell schwannoma extending in lateral over the C1 arch and displacing the C3 segment of the vertebral artery superiorly and anteriorly. Complete removal of the tumor was achieved using a far lateral approach. The approach is discussed with focus on the vertebral artery anatomy as the approach should give enough space to gain control of the artery without creating instability. Safe removal of C1 nerve root schwanomas can be achieved even if they compress and displace the vertebral artery by entering a fibrous tissue plane between the tumor and the vertebral artery.

scholarly journals A Case of Foramen Magnum and C1–C2 Meningiomas: Double Challenge, One Approach

2020 ◽  
Author(s):  
Giada Toccaceli ◽  
Roberto Altieri ◽  
Francesco Certo ◽  
Giuseppe Barbagallo
Keyword(s):  
Vertebral Artery ◽  
Spastic Paraparesis ◽  
Craniovertebral Junction ◽  
Skin Incision ◽  
Foramen Magnum ◽  
Neurophysiological Monitoring ◽  
Upper Cervical Spine ◽  
Recent Onset ◽  
Suboccipital Craniotomy ◽  
The Right

Abstract Objectives We present a challenging case of a 61-year-old male patient with a double meningioma. The first one was located on the right side of foramen magnum and the second one was located on left anterolateral side of C1–C2. Background Patient referred at our institution for a progressive spastic paraparesis from approximately 1 year with a recent onset of numbness in right hand. Neuroradiological imaging showed an extra-axial enhancing tumor with a dural tail on the right border of foramen magnum and another contralateral extra-axial enhancing lesion at C1–C2 level (Fig. 1). Results We have chosen a park bench position. Neurophysiological monitoring was used during both positioning and surgery. A linear skin incision in the occipital region extended to C7 was performed and a suboccipital craniotomy with the laminectomy of C1–C3 was performed (Fig. 2). Videofluroangiography was performed to the best visualization of the vertebral artery position during microsurgical dissection and exposure of craniovertebral junction region. An Y-shape dural opening was executed and two meningiomas was resected with the classical four D steps (devascularize, detach, debulking, and dissect). All anatomical structures were respected and there were no changes at neuromonitoring. Patient was discharged after 10 days in good neurological condition. Conclusion a single approach for multiple meningiomas of the craniovertebral junction and upper cervical spine region is feasible and effective. Videofluoroangiography as a way to achieve better visualization and control of the vertebral artery, and neurophysiological monitoring are crucial tools to reduce the morbidity of this surgical challenge.The link to the video can be found at: https://youtu.be/4w9HCfQZkgg.

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