Vertebrobasilar insufficiency secondary to vertebral artery occlusion from a fibrous band

✓ A case is described in which vertebral artery occlusion, caused by a fibrous band, occurred whenever the patient turned his head to the right side, resulting in vertigo and syncope whenever the head was turned to the right. Release of a fibrous band crossing the vertebral artery 2 cm from its origin relieved the patient's vertebral artery constriction and symptoms.

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Ligation of the vertebral (unilateral or bilateral) or basilar artery in the treatment of large intracranial aneurysms

Journal of Neurosurgery ◽

10.3171/jns.1975.43.3.0255 ◽

1975 ◽

Vol 43 (3) ◽

pp. 255-274 ◽

Cited By ~ 144

Author(s):

Charles G. Drake

Keyword(s):

Vertebral Artery ◽

Basilar Artery ◽

Artery Occlusion ◽

Collateral Flow ◽

Patient Death ◽

Artery Ligation ◽

Content Type ◽

Vertebral Artery Occlusion ◽

Complete Thrombosis ◽

Fine Print

✓ The author reports the use of vertebral artery ligation, unilateral and bilateral, for the treatment of large vertebral-basilar aneurysms in 14 patients with one delayed death. Extracranial ligation was carried out unilaterally with a Selverstone clamp in three patients. In two, where the aneurysm filled only from one vertebral artery, there was extensive thrombosis within the sac and dramatic clinical improvement after decompression. Extracranial ligation was done bilaterally in three patients, temporarily in two. A 14-year-old boy is well after 5 years but the bilateral vertebrobasilar aneurysm did not undergo extensive thrombosis until both vertebral arteries were occluded at their intracranial entrance above collateral flow. In two others, the clamp had to be reopened on the second artery. In one patient, death from delayed thrombosis of a huge aneurysm and pontine infarction might have been prevented with anticoagulants. In the other, the aneurysm ruptured again fatally 18 months later. Unilateral intracranial occlusion of a vertebral artery was done in eight cases, with no morbidity and complete or nearly complete thrombosis in all but one aneurysm. Seven patients had excellent or good results while one showed little recovery from an existing medullary syndrome. Occlusion of the basilar artery was done in seven cases. In five it was used deliberately as the only treatment, but in two it was forced when an aneurysm burst during dissection. Only two of the patients in the first group and one of the second group have made complete recoveries. The results of vertebral artery occlusion are encouraging and the technique deserves further consideration. Extensive collateral circulation enhances the safety of cervical vertebral artery occlusion but can be of a degree to make the occlusion ineffective. For intracranial occlusion knowledge of the size and distribution of each vertebral artery is essential. Occlusion of the basilar artery is dangerous, although it seems to be effective in producing extensive thrombosis in the aneurysm. It should probably be done under anesthesia only when the artery fills spontaneously from the carotid circulation. Otherwise, even when reasonable posterior communicating arteries are demonstrated, it is best to test occlusion under local anesthesia.

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Posttraumatic bilateral vertebral artery occlusion

Journal of Neurosurgery ◽

10.3171/jns.1981.54.6.0814 ◽

1981 ◽

Vol 54 (6) ◽

pp. 814-817 ◽

Cited By ~ 37

Author(s):

Eric G. Six ◽

W. Lynn Stringer ◽

A. Ron Cowley ◽

Courtland H. Davis

Keyword(s):

Vertebral Artery ◽

Artery Occlusion ◽

Posterior Fixation ◽

Kirschner Wires ◽

Content Type ◽

Vertebral Arteries ◽

Vertebral Artery Occlusion ◽

Neurologically Normal ◽

Collateral Vessels ◽

Fine Print

✓ A case of bilateral vertebral artery occlusion following trauma in a 25-year-old woman is presented. The patient had minimal subluxation of C-2 on C-3 without neurological deficit. Her neck was immobilized for 16 days, and then a posterior fixation of C-1 through C-4 was performed with Kirschner wires and methyl methacrylate. Occlusion of the vertebral arteries has persisted, but collateral vessels are adequate and the patient has remained neurologically normal.

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Rotational obstruction of nondominant vertebral artery and ischemia

Journal of Neurosurgery ◽

10.3171/jns.1996.85.3.0507 ◽

1996 ◽

Vol 85 (3) ◽

pp. 507-509 ◽

Cited By ~ 20

Author(s):

Tetsuya Morimoto ◽

Takanobu Kaido ◽

Yoshitomo Uchiyama ◽

Hidemori Tokunaga ◽

Toshisuke Sakaki ◽

...

Keyword(s):

Vertebral Artery ◽

Three Dimensional ◽

Artery Occlusion ◽

Left Vertebral Artery ◽

Posterior Fixation ◽

Vertebrobasilar Insufficiency ◽

Atlantoaxial Joint ◽

Head Turning ◽

Content Type ◽

The Right

✓ A 70-year-old man presented with repeated vertebrobasilar insufficiency for 3 years. Four-vessel angiography revealed complete occlusion of the nondominant left vertebral artery on head turning to the right. Three-dimensional computerized tomography angiography demonstrated atlantoaxial joint dislocation when the head was turned to the right, in accordance with simultaneous occlusion of the left vertebral artery caused by stretching of the artery at C1–2. After posterior fixation of C1–2 by a Halifax interlaminar fixation system, the patient had no further episodes. Hemodynamic function associated with nondominant vertebral artery occlusion contributed to the symptoms in this case.

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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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Rotational vertebral artery occlusion: Case report and review of literature

Journal of Clinical Case reports and reviews ◽

10.36879/jccrr.18.000115 ◽

2018 ◽

pp. 1-3

Keyword(s):

Vertebral Artery ◽

Head Rotation ◽

Transcranial Doppler Ultrasound ◽

Artery Occlusion ◽

Vascular Lesion ◽

Vascular Compression ◽

Vertebrobasilar Insufficiency ◽

Transverse Foramen ◽

Vertebral Artery Occlusion ◽

The Right

Rotational vertebral artery occlusion (RVAO) classically involves transient, position-dependent vertebrobasilar insufficiency (VBI) that occurs when an extra-vascular lesion (e.g. osteophyte or fibromuscular band) compresses a dominant vertebral artery with turning of the head to one side. Our patient presented with VBI associated vertigo, dizziness, and lightheadedness that occurred when her head was turned to the right. RVAO was initially suggested by transcranial Doppler ultrasound (TCD) changes that were not supported by initial catheter angiography. After her symptoms worsened over a course of two years, the diagnosis was confirmed with repeat angiography with head rotation. Further imaging with computed tomography and magnetic resonance demonstrated spondylosis at the C5-C6 vertebrae and an osteophyte near the C5 transverse foramen, which caused position-dependent extra-vascular compression. She was treated with surgical decompression and anterior discectomy and fusion at C5-C6. The unique anatomical pathology of this case combined with the diagnostic discrepancy between early TCD and angiography make it an interesting contribution to the otherwise limited body of literature on RVAO.

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Anterolateral decompression of the atlantoaxial vertebral artery for symptomatic positional occlusion of the vertebral artery

Journal of Neurosurgery ◽

10.3171/jns.1995.83.4.0737 ◽

1995 ◽

Vol 83 (4) ◽

pp. 737-740 ◽

Cited By ~ 46

Author(s):

Mark W. Fox ◽

David G. Piepgras ◽

John D. Bartleson

Keyword(s):

Vertebral Artery ◽

Head Rotation ◽

Artery Occlusion ◽

Left Vertebral Artery ◽

Vertebrobasilar Insufficiency ◽

Mechanical Compression ◽

Head Turning ◽

Content Type ◽

The Right ◽

Bow Hunter’S Stroke

✓ A case of repeated vertebrobasilar ischemic attacks related to head rotation (bow hunter's stroke) is reported. With head rotation of 45° or more to the right, the patient would become lightheaded and feel as if she were going to lose consciousness. Angiography performed when head rotation was to the right revealed mechanical compression of the left vertebral artery at the foramen transversarium of the axis and an occluded right vertebral artery. Untethering of the vertebral artery as it passed through the foramen transversarium of the atlas in this case completely relieved the patient's symptoms. The authors conclude that contralateral vertebral artery occlusion predisposed this patient to symptomatic vertebrobasilar insufficiency secondary to ipsilateral vertebral artery mechanical stenosis induced by head turning.

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Rotational vertebrobasilar insufficiency secondary to vertebral artery occlusion from fibrous band of the longus coli muscle

Neuroradiology ◽

10.1007/bf02426468 ◽

1990 ◽

Vol 32 (6) ◽

pp. 514-515 ◽

Cited By ~ 31

Author(s):

M. R. Dadsetan ◽

H. E. I. Skerhut

Keyword(s):

Vertebral Artery ◽

Artery Occlusion ◽

Vertebrobasilar Insufficiency ◽

Fibrous Band ◽

Vertebral Artery Occlusion

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Deliberate basilar or vertebral artery occlusion in the treatment of intracranial aneurysms

Journal of Neurosurgery ◽

10.3171/jns.1993.79.2.0161 ◽

1993 ◽

Vol 79 (2) ◽

pp. 161-173 ◽

Cited By ~ 240

Author(s):

Gary K. Steinberg ◽

Charles G. Drake ◽

Sydney J. Peerless

Keyword(s):

Clinical Outcome ◽

Vertebral Artery ◽

Brain Stem ◽

Intracranial Aneurysms ◽

Artery Occlusion ◽

Neurological Deterioration ◽

Content Type ◽

Vertebrobasilar Junction ◽

Aneurysm Thrombosis ◽

Fine Print

✓ Deliberate occlusion of the basilar or vertebral arteries was performed in 201 patients with intracranial aneurysms, where the aneurysmal neck could not be clipped directly. The aneurysms arose from the basilar apex in 83 cases, the basilar trunk in 46, the vertebrobasilar junction in 35, and the vertebral artery in 37; 87% of the aneurysms were classified as giant lesions (> 2.5 cm). There were 85 upper basilar occlusions, 41 lower basilar occlusions, 29 bilateral vertebral occlusions, and 48 unilateral vertebral artery occlusions. The clinical follow-up period varied from 1 to 23 years, with a mean of 9.5 years. Overall long-term results were excellent in 68% of the patients, good in 5%, and poor in 3%; 24% died. Clinical outcome varied according to aneurysm site; excellent or good results were achieved in 64% of the patients with basilar apex, 76% with basilar trunk, 74% with vertebrobasilar junction, and 87% with vertebral artery aneurysms. Clinical outcome also varied depending on preoperative grade: 86% of the patients with an excellent presenting grade achieved excellent results. The size of the posterior communicating arteries was a good predictor of tolerance to basilar artery occlusion (p < 0.05). Successful aneurysm thrombosis was achieved in 78% of the patients. The neurological status in 26 patients (13%) deteriorated due to vertebrobasilar ischemia occurring within the 1st postoperative week, and thrombosis or embolism was implicated much more frequently than hemodynamic insufficiency. Subarachnoid hemorrhage (SAH) in 14 patients, vasospasm in five patients, and surgical trauma in seven patients accounted for additional morbidity in the 1st month following operation; however, many of these patients ultimately made an excellent recovery. Late vertebrobasilar ischemic complications or neurological deterioration from persistent mass effect occurred in 4% of patients with successful aneurysm thrombosis 6 weeks to 18 months after arterial ligation. Among the 43 patients with incompletely thrombosed aneurysms, 67% developed early or late neurological deterioration from SAH, progressive brain-stem compression, or brain-stem stroke, with 86% of the complications proving fatal.

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Microvascular anatomy of foramen caecum medullae oblongatae

Journal of Neurosurgery ◽

10.3171/jns.1991.75.2.0299 ◽

1991 ◽

Vol 75 (2) ◽

pp. 299-304 ◽

Cited By ~ 45

Author(s):

Asim Mahmood ◽

Manuel Dujovny ◽

Maximo Torche ◽

Ljubisa Dragovic ◽

James I. Ausman

Keyword(s):

Vertebral Artery ◽

Basilar Artery ◽

Foramen Magnum ◽

Left Vertebral Artery ◽

Anterior Inferior Cerebellar Artery ◽

Outer Diameter ◽

Vertebrobasilar Insufficiency ◽

High Concentration ◽

Content Type ◽

Fine Print

✓ The foramen caecum (FC) is a triangular-shaped fossa situated in the midline on the base of the brain stem, at the pontomedullary junction. Although this area is known to have a very high concentration of brainstem perforating vessels, its microvascular anatomy has not been studied in detail. The purpose of this study was to detail the microvasculature of this territory. Twenty unfixed brains were injected with silicone rubber solution and dissected under a microscope equipped with a camera. The origin, course, outer diameter, and branching pattern of the perforators were examined. The total number of perforators found in the 20 brains was 287, with an average (± standard deviation) of 14.35 ± 1.24 perforators per brain (range seven to 28). Their origin was as follows: right vertebral artery in 52 perforators (18.11%); left vertebral artery in 35 (12.19%); basilar artery below the anterior inferior cerebellar artery (AICA) in 139 (48.43%); basilar artery above the AICA in 46 (16.02%); AICA in 10 (3.48%); and anterior spinal artery in five (1.74%). Most of the perforators arose as sub-branches of larger trunks; their average outer diameter was 0.16 ± 0.006 mm while that of trunks was 0.35 ± 0.02 mm. These anatomical data are important for those wishing 1) to study the pathophysiology of vascular insults to this area caused by atheromas, thrombi, and emboli; 2) to plan vertebrobasilar aneurysm surgery; 3) to plan surgery for vertebrobasilar insufficiency; and 4) to study foramen magnum neoplasms.

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