A case of bow hunter's stroke due to anomalies of the craniocervical junction and tortuous vertebral artery detected by carotid ultrasonography

Neurosonology ◽  
2010 ◽  
Vol 23 (1) ◽  
pp. 17-22
Author(s):  
Hiromi SUZUKI ◽  
Masanori HONDA
Keyword(s):  
Vertebral Artery ◽  
Craniocervical Junction ◽  
Carotid Ultrasonography ◽  
Bow Hunter’S Stroke

Stab Wounds at the Craniocervical Junction

Neurosurgery ◽  
1985 ◽  
Vol 17 (6) ◽  
pp. 930-936 ◽  
Author(s):  
J.C. de Villiers ◽  
A. R. Grant
Keyword(s):  
Vertebral Artery ◽  
Surgical Repair ◽  
False Aneurysm ◽  
Craniocervical Junction ◽  
Artery Occlusion ◽  
Cerebrospinal Fluid Leakage ◽  
Warning Sign ◽  
Upper Limbs ◽  
Stab Wounds ◽  
Anatomical Features

Abstract Between 1976 and 1984, 11 patients with stab wounds at the craniocervical junction were seen in the Department of Neurosurgery at Groote Schuur Hospital. The injury usually occurred in males, and the left side was predominantly involved. Because of the anatomical features of this region, the penetrating instrument is deflected by the occipital squama into the atlantooccipital or atlantoaxial interspace, and an almost predictable syndrome occurs. The dura mater is penetrated, so that cerebrospinal fluid leakage and meningitis are common complications (meningitis occurred in 5 patients). A meningocele may develop at this site and did occur in 4 patients, but only 2 required surgical repair. Because of the exposed position of the vertebral artery at this level, this vessel was injured in 4 patients; an arteriovenous fistula developed in 2, vertebral artery occlusion occurred in 1, and a false aneurysm developed in another patient. The neurological deficit varied in magnitude, was often transient, affected the upper limbs more than the lower, was asymmetrical (suggestive of lateralized injury), and at times showed a remarkable tendency to recover. Awareness of the existence of this syndrome may help in forestalling complications. The only warning sign may be an insignificant wound in the suboccipital or retromastoid region.

Endoscope-assisted far-lateral transcondylar approach for craniocervical junction chordomas: a retrospective case series and cadaveric dissection

2021 ◽  
pp. 1-12
Author(s):  
Arianna Fava ◽  
Paolo di Russo ◽  
Valentina Tardivo ◽  
Thibault Passeri ◽  
Breno Câmara ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Tumor Resection ◽  
Case Series ◽  
Craniocervical Junction ◽  
Anatomical Landmarks ◽  
Total Resection ◽  
Female Ratio ◽  
Cadaveric Dissection ◽  
Transcondylar Approach ◽  
Far Lateral

OBJECTIVE Craniocervical junction (CCJ) chordomas are a neurosurgical challenge because of their deep localization, lateral extension, bone destruction, and tight relationship with the vertebral artery and lower cranial nerves. In this study, the authors present their surgical experience with the endoscope-assisted far-lateral transcondylar approach (EA-FLTA) for the treatment of CCJ chordomas, highlighting the advantages of this corridor and the integration of the endoscope to reach the anterior aspect and contralateral side of the CCJ and the possibility of performing occipitocervical fusion (OCF) during the same stage of surgery. METHODS Nine consecutive cases of CCJ chordomas treated with the EA-FLTA between 2013 and 2020 were retrospectively reviewed. Preoperative characteristics, surgical technique, postoperative results, and clinical outcome were analyzed. A cadaveric dissection was also performed to clarify the anatomical landmarks. RESULTS The male/female ratio was 1.25, and the median age was 36 years (range 14–53 years). In 6 patients (66.7%), the lesion showed a bilateral extension, and 7 patients (77.8%) had an intradural extension. The vertebral artery was encased in 5 patients. Gross-total resection was achieved in 5 patients (55.6%), near-total resection in 3 (33.3%), and subtotal resection 1 (11.1%). In 5 cases, the OCF was performed in the same stage after tumor removal. Neither approach-related complications nor complications related to tumor resection occurred. During follow-up (median 18 months, range 5–48 months), 1 patient, who had already undergone treatment and radiotherapy at another institution and had an aggressive tumor (Ki-67 index of 20%), showed tumor recurrence at 12 months. CONCLUSIONS The EA-FLTA provides a safe and effective corridor to resect extensive and complex CCJ chordomas, allowing the surgeon to reach the anterior, lateral, and posterior portions of the tumor, and to treat CCJ instability in a single stage.

scholarly journals Occipitoaxial spinal interarticular stabilization with vertebral artery preservation for atlantal lateral mass failure

2015 ◽  
Vol 22 (2) ◽  
pp. 134-138 ◽  
Author(s):  
Lukas Bobinski ◽  
Marc Levivier ◽  
John M. Duff
Keyword(s):  
Vertebral Artery ◽  
Tumor Resection ◽  
Craniocervical Junction ◽  
Single Stage ◽  
Lateral Mass ◽  
One Stage ◽  
Craniocervical Instability ◽  
Mass Failure ◽  
Titanium Cages ◽  
Mass Reconstruction

The treatment of craniocervical instability caused by diverse conditions remains challenging. Different techniques have been described to stabilize the craniocervical junction. The authors present 2 cases in which tumoral destruction of the C-1 lateral mass caused craniocervical instability. A one-stage occipitoaxial spinal interarticular stabilization (OASIS) technique with titanium cages and posterior occipitocervical instrumentation was used to reconstruct the C-1 lateral mass and stabilize the craniocervical junction. The ipsilateral vertebral artery was preserved. The OASIS technique offers single-stage tumor resection, C-1 lateral mass reconstruction, and stabilization with a loadsharing construct. It could be an option in the treatment of select cases of C-1 lateral mass failure.

scholarly journals Surgical Treatment of a Case with Bow Hunter's Stroke caused by C2 Cervical Nerve Traction of the Vertebral Artery

2003 ◽  
Vol 17 (1) ◽  
pp. 35-40 ◽  
Author(s):  
Kanji Yamane ◽  
Takeshi Shima ◽  
Masahiro Nishida ◽  
Takashi Hatayama ◽  
Chie Mihara ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Vertebral Artery ◽  
Cervical Nerve ◽  
Bow Hunter’S Stroke

Compression Syndromes of the Vertebral Artery at the Craniocervical Junction

2019 ◽  
pp. 151-158
Author(s):  
Jan Frederick Cornelius ◽  
Raoul Pop ◽  
Marco Fricia ◽  
Bernard George ◽  
Salvatore Chibbaro
Keyword(s):  
Vertebral Artery ◽  
Craniocervical Junction ◽  
Compression Syndromes

Abstract T P103: Vertebral Artery Hypoplasia Should Play Important Role for Posterior Circulation Ischemia

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Hidetaka Mitsumura ◽  
Teppei Komatsu ◽  
Shinji Miyagawa ◽  
Yuki Sakamoto ◽  
Toshiaki Hirai ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Confidence Interval ◽  
Vertebral Artery ◽  
Prevalence Rate ◽  
Odds Ratio ◽  
Multivariate Regression ◽  
Posterior Circulation ◽  
Large Artery ◽  
Carotid Ultrasonography ◽  
Vertebral Artery Hypoplasia

Purpose: Vertebral artery hypoplasia (VAH) is congenital anatomical variation, which is frequently observed in clinical situation. In previous reports, it was not unclear whether VAH was the independent risk factor for posterior circulation ischemia. The purpose of this study is to evaluate an impact of VAH on posterior circulation ischemia. Methods: Subjects were patients with acute ischemic stroke who underwent brain MRI and carotid ultrasonography. The diameter of vessel and flow velocities of extracranial vertebral artery (VA) was measured by carotid ultrasonography. Diagnostic criteria of VAH was as follows: 1) diameter of VA <2.5mm, 2) diameter of VA <3.0mm and a side difference equal or greater than 1:1.7, 3) diameter of VA <3.0mm, peak systolic velocity <40cm/sec, and resistance index value >0.75. We divided all patients into three groups by the location of the acute ischemic stroke evaluated by MRI: ischemic lesion on posterior circulation (P group), on anterior circulation (A group), and multiple lesions on both anterior and posterior circulation (AP group). Then, the prevalence rate of VAH was compared between P group and A+AP group. In order to evaluate independent factors of VA occlusion, we conducted multivariate regression analyses. Results: We evaluated a total of 129 consecutive patients (87 male, median age; 71 years). P group was 36 patients, and A+AP group was 93 patients. VAH was seen in 39 patients (31.5%), and VA occlusion was found in 15 patients. The prevalence rate of VAH in P group (44.4%) was significantly higher than in A+AP group (24.7%, p=0.034). In univariate analysis, the patients with VA occlusion were higher rates of hypertension (p=0.066), large artery atherosclerosis (p=0.095), posterior circulation ischemia (p=0.001), and the presence of VAH (p=0.038). Multivariate regression analysis demonstrated that large artery atherosclerosis (odds ratio, 6.3; 95% confidence interval, 1.3-30.1), posterior circulation ischemia (odds ratio, 12.0; 95% confidence interval, 2.8-51.2) and VAH (odds ratio, 4.2; 95% confidence interval, 1.2-15.0) were independently associated with the presence of VA occlusion. Conclusion: VAH was independent factor of VA occlusion, and should be associated with posterior circulation ischemia.

Vertebral Artery Surgery - An Overview of Techniques and Discussion Points for the Future

2011 ◽  
Vol 6 (3) ◽  
pp. 193
Author(s):  
Bernard George ◽  
Keyword(s):  
Vertebral Artery ◽  
Jugular Foramen ◽  
Craniocervical Junction ◽  
Foramen Magnum ◽  
Surgical Anatomy ◽  
Surgical Approaches ◽  
Arteriovenous Fistulas ◽  
Intermittent Compression ◽  
Safety And Reliability ◽  
And Control

The vertebral artery (VA) is an important vessel supplying the hind brain; its surgical exposure and control is usually considered a great challenge. In fact, with good knowledge of surgical anatomy and proper surgical technique, the VA can be controlled and occasionally repaired with safety and reliability. VA exposure is useful in many instances and helps attain better results in the surgical treatment of many different pathologies at any level all along its course in the neck and the skull. These pathologies include intrinsic lesions (atherosclerosis, aneurysms, arteriovenous fistulas), intermittent compression by osteophytes or fibrous bands, and permanent compression mostly by different types of tumours. VA exposure also helps to achieve better treatment of spondylotic myelopathy (by oblique corpectomy) and of tumours at the craniocervical junction, foramen magnum and jugular foramen level. Based on the experience of more than 1,600 surgical approaches, VA surgery is associated with a very limited morbidity and mortality.

Decompression of the vertebral artery for bow-hunter's stroke

1988 ◽  
Vol 69 (1) ◽  
pp. 127-131 ◽  
Author(s):  
Takeo Shimizu ◽  
Shiro Waga ◽  
Tadashi Kojima ◽  
Shigehiko Niwa
Keyword(s):  
Vertebral Artery ◽  
Thrombus Formation ◽  
Surgical Decompression ◽  
Cerebellar Infarction ◽  
Neck Movement ◽  
Content Type ◽  
Neck Rotation ◽  
Bow Hunter’S Stroke ◽  
Good Flow ◽  
Fine Print

✓ A case of cerebellar infarction induced by repeated neck rotation (“bow-hunter's stroke”) is reported. The most likely mechanism is that repeated rotational neck movement brings about thickening of the atlanto-occipital membrane, fixing the vertebral artery in the vascular groove of the atlas. The vertebral artery is thus pinched at the time of neck rotation, leading to thrombus formation. Embolization results in cerebellar infarction. Surgical decompression of the vertebral artery at the level of the atlas in this case relieved the symptoms, and postoperative angiography demonstrated good flow within the vertebral artery even when the neck was rotated. It was not necessary to restrict the patient's neck movement postoperatively.

Craniocervical Junction Vertebral Artery Dural Arteriovenous Fistula With Cranial and Spinal Venous Reflux: 2-Dimensional Operative Video

2019 ◽  
Vol 18 (5) ◽  
pp. E162-E163 ◽  
Author(s):  
Krunal Patel ◽  
Leonardo Desessards Olijnyk ◽  
Anderson Chun On Tsang ◽  
Vitor Mendes Pereira ◽  
Ivan Radovanovic
Keyword(s):  
Vertebral Artery ◽  
Arteriovenous Fistula ◽  
Dural Arteriovenous Fistula ◽  
Craniocervical Junction ◽  
Lateral Approach ◽  
Venous Reflux ◽  
Suboccipital Craniotomy ◽  
Far Lateral Approach ◽  
Key Steps ◽  
Midline Approach

Abstract Dural arteriovenous fistulae at the craniocervical junction are rare. When present together with spinal and cranial venous reflux they can have an aggressive natural history with hemorrhage or progressive myelopathy from venous congestion. In this operative video we demonstrate key steps in the surgical ligation of a dural arteriovenous fistula supplied by meningeal branches of the V4 segment of the vertebral artery.  Informed consent was obtained. The patient was positioned prone with chin tucked. Utilizing a midline suboccipital craniotomy and removal of the arch of C1, the vertebral artery was identified at its V4 segment at it transitions from extra to intradural. The video illustrates how a midline approach can be used to access this lesion and a far lateral approach is not required to access the vertebral artery and its dural branches at the craniocervical junction. Division of the denticulate ligaments and mobilization of the spinal accessory nerve allows visualization of the proximal portion of the draining vein. Important anatomy in this region is demonstrated. The critical use of indocyanine green (ICG) dye is demonstrated as the first 2 clip applications were not proximal enough to obliterate the proximal draining vein and persistent early venous reflux was still seen on ICG. The importance of access to and obliteration of the proximal draining vein is shown. An intraoperative ICG and postoperative angiogram demonstrates complete occlusion of the dural arteriovenous fistula.  In this case the patient had minor sensory deficits postoperatively which were resolved by 6 wk postoperatively.

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