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

2002 ◽  
Vol 97 (6) ◽  
pp. 1456-1459 ◽  
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.

Vertebrobasilar insufficiency secondary to vertebral artery occlusion from a fibrous band

1982 ◽  
Vol 56 (4) ◽  
pp. 581-583 ◽  
Author(s):  
Timothy Mapstone ◽  
Robert F. Spetzler
Keyword(s):  
Vertebral Artery ◽  
Artery Occlusion ◽  
Vertebrobasilar Insufficiency ◽  
Fibrous Band ◽  
Content Type ◽  
Vertebral Artery Occlusion ◽  
The Right ◽  
Band Crossing ◽  
Fine Print

✓ 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.

Rotational obstruction of nondominant vertebral artery and ischemia

1996 ◽  
Vol 85 (3) ◽  
pp. 507-509 ◽  
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.

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

2004 ◽  
Vol 1 (3) ◽  
pp. 338-341 ◽  
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.

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

1993 ◽  
Vol 79 (2) ◽  
pp. 161-173 ◽  
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.

Craniovertebral junction fixation with transarticular screws: biomechanical analysis of a novel technique

2003 ◽  
Vol 98 (2) ◽  
pp. 202-209 ◽  
Author(s):  
L. Fernando Gonzalez ◽  
Neil R. Crawford ◽  
Robert H. Chamberlain ◽  
Luis E. Perez Garza ◽  
Mark C. Preul ◽  
...  
Keyword(s):  
Three Dimensional ◽  
Axial Rotation ◽  
Craniovertebral Junction ◽  
Biomechanical Analysis ◽  
Lateral Bending ◽  
Content Type ◽  
Additional Stability ◽  
A New Technique ◽  
Flexion And Extension ◽  
Fine Print

Object. The authors compared the biomechanical stability resulting from the use of a new technique for occipitoatlantal motion segment fixation with an established method and assessed the additional stability provided by combining the two techniques. Methods. Specimens were loaded using nonconstraining pure moments while recording the three-dimensional angular movement at occiput (Oc)—C1 and C1–2. Specimens were tested intact and after destabilization and fixation as follows: 1) Oc—C1 transarticular screws plus C1–2 transarticular screws; 2) occipitocervical transarticular (OCTA) plate in which C1–2 transarticular screws attach to a loop from Oc to C-2; and (3) OCTA plate plus Oc—C1 transarticular screws. Occipitoatlantal transarticular screws reduced motion to well within the normal range. The OCTA loop and transarticular screws allowed a very small neutral zone, elastic zone, and range of motion during lateral bending and axial rotation. The transarticular screws, however, were less effective than the OCTA loop in resisting flexion and extension. Conclusions. Biomechanically, Oc—C1 transarticular screws performed well enough to be considered as an alternative for Oc—C1 fixation, especially when instability at C1–2 is minimal. Techniques for augmenting these screws posteriorly by using a wired bone graft buttress, as is currently undertaken with C1–2 transarticular screws, may be needed for optimal performance.

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

1975 ◽  
Vol 43 (3) ◽  
pp. 255-274 ◽  
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.

Dural arteriovenous malformation in the posterior fossa associated with intracerebellar hematoma

1984 ◽  
Vol 60 (5) ◽  
pp. 1067-1069 ◽  
Author(s):  
Saburo Sakaki ◽  
Hitoshi Fujita ◽  
Kanehisa Kohno ◽  
Kenzo Matsuoka
Keyword(s):  
Arteriovenous Malformation ◽  
Vertebral Artery ◽  
Posterior Fossa ◽  
Dural Arteriovenous Malformation ◽  
Content Type ◽  
The Right ◽  
Fine Print

✓ A case of an infratentorial dural arteriovenous malformation associated with an intracerebellar hematoma is reported. This malformation was fed by meningeal branches of the right vertebral artery and was drained exclusively by pial veins in the posterior fossa.

Acute hemorrhage into pituitary adenoma with SAH and anterior cerebral artery occlusion

1983 ◽  
Vol 58 (5) ◽  
pp. 771-773 ◽  
Author(s):  
Henryk Majchrzak ◽  
Tadeusz Wencel ◽  
Tadeusz Dragan ◽  
Joanna Bialas
Keyword(s):  
Cerebral Artery ◽  
Anterior Cerebral Artery ◽  
Artery Occlusion ◽  
Loss Of Consciousness ◽  
Artery Blood Flow ◽  
Acute Hemorrhage ◽  
Content Type ◽  
The Right ◽  
Cerebral Artery Occlusion ◽  
Fine Print

✓ The authors present the case of a patient with a pituitary tumor, who manifested signs of subarachnoid hemorrhage (SHA) and loss of consciousness. After he had regained consciousness, massive left-sided paralysis was noted. Angiography and computerized tomography showed hemorrhage into the tumor, SAH, and ischemia of the right frontal lobe as a result of occlusion of the anterior cerebral artery. Removal of the tumor 3 weeks after the SAH did not lead to resumption of the anterior cerebral artery blood flow.

Posterolateral protrusion of the vertebral artery over the posterior arch of the atlas: quantitative anatomical study using three-dimensional computed tomography angiography

2008 ◽  
Vol 9 (2) ◽  
pp. 167-174 ◽  
Author(s):  
Satoshi Yamaguchi ◽  
Kuniki Eguchi ◽  
Yoshihiro Kiura ◽  
Masaaki Takeda ◽  
Kaoru Kurisu
Keyword(s):  
Vertebral Artery ◽  
Ct Angiography ◽  
Preoperative Evaluation ◽  
Posterior Inferior Cerebellar Artery ◽  
Three Dimensional ◽  
Anatomical Variations ◽  
Posterior Arch ◽  
Outer Cortex ◽  
The Right ◽  
Dominant Side

Object The vertebral artery (VA) often takes a protrusive course posterolaterally over the posterior arch of the atlas. In this study, the authors attempted to quantify this posterolateral protrusion of the VA. Methods Three-dimensional CT angiography images obtained for various cranial or cervical diseases in 140 patients were reviewed and evaluated. Seven patients were excluded for various reasons. To quantify the protrusive course of the VA, the diameter of the VA and 4 parameters were measured in images of the C1–VA complex obtained in the remaining 133 patients. The authors also checked for anomalies and anatomical variations. Results When there was no dominant side, mean distances from the most protrusive part of the VA to the posterior arch of the atlas were 6.73 ± 2.35 mm (right) and 6.8 ± 2.15 mm (left). When the left side of the VA was dominant, the distance on the left side (8.46 ± 2.00 mm) was significantly larger than that of the right side (6.64 ± 2.0 mm). When compared by age group (≤ 30 years, 31–60 years, and ≥ 61 years), there were no significant differences in the extent of the protrusion. When there was no dominant side, the mean distances from the most protrusive part of the VA to the midline were 30.73 ± 2.51 mm (right side) and 30.79 ± 2.47 mm (left side). When the left side of the VA was dominant, the distance on the left side (32.68 ± 2.03 mm) was significantly larger than that on the right side (29.87 ± 2.53 mm). The distance from the midline to the intersection of the VA and inner cortex of the posterior arch of the atlas was ~ 12 mm, irrespective of the side of VA dominance. The distance from the midline to the intersection of the VA and outer cortex of the posterior arch was ~ 20 mm on both sides. Anatomical variations and anomalies were found as follows: bony bridge formation over the groove for the VA on the posterior arch of C-1 (9.3%), an extracranial origin of the posterior inferior cerebellar artery (8.2%), and a VA passing beneath the posterior arch of the atlas (1.8%). Conclusions There may be significant variation in the location and branches of the VA that may place the vessel at risk during surgical intervention. If concern is noted about the vulnerability of the VA or its branches during surgery, preoperative evaluation by CT angiography should be considered.

Morphometric Anatomy of the Posterior Aspect of the Atlas and the Vertebral Artery Groove in Relation to Lateral Mass Screw Placement

2021 ◽  
Author(s):  
Selda Aksoy ◽  
Bulent Yalcin
Keyword(s):  
Vertebral Artery ◽  
Screw Placement ◽  
Atlantoaxial Instability ◽  
Posterior Arch ◽  
Lateral Mass ◽  
Lateral Mass Screw ◽  
Entry Zone ◽  
Mean Width ◽  
The Mean ◽  
The Right

Abstract Background Atlantoaxial instability is an important disorder that causes serious symptoms such as difficulties in walking, limited neck mobility, sensory deficits, etc. Atlantal lateral mass screw fixation is a surgical technique that has gained important recognition and popularity. Because accurate drilling area for screw placement is of utmost importance for a successful surgery, we aimed to investigate morphometry of especially the posterior part of C1. Methods One hundred and fifty-eight human adult C1 dried vertebrae were obtained. Measurements were performed directly on dry atlas vertebrae, and all parameters were measured by using a digital caliper accurate to 0.01 mm for linear measurements. Results The mean distance between the tip of the posterior arch and the medial inner edge of the groove was found to be 10.59 ± 2.26 and 10.49 ± 2.20 mm on the right and left, respectively. The mean distance between the tip of the posterior arch and the anterolateral outer edge of the groove was 21.27 ± 2.28 mm (right: 20.96 ± 2.22 mm; left: 21.32 ± 2.27 mm). The mean height of the screw entry zone on the right and left sides, respectively, were 3.86 ± 0.81 and 3.84 ± 0.77 mm. The mean width of the screw entry zone on both sides was 13.15 ± 1.17 and 13.25 ± 1.3 mm. Conclusion Our result provided the literature with a detailed database for the morphometry of C1, especially in relation to the vertebral artery groove. We believe that the data in the present study can help surgeons to adopt a more accurate approach in terms of accurate lateral mass screw placement in atlantoaxial instability.

Sign in / Sign up

Export Citation Format

Share Document