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.

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

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.

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.

Rotational occlusion of the vertebral artery caused by transverse process hyperrotation and unilateral apophyseal joint subluxation

1997 ◽  
Vol 86 (6) ◽  
pp. 1031-1035 ◽  
Author(s):  
Tetsuro Kawaguchi ◽  
Shigekiyo Fujita ◽  
Kohkichi Hosoda ◽  
Yuji Shibata ◽  
Masaki Iwakura ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Three Dimensional ◽  
Head Rotation ◽  
Transverse Process ◽  
Content Type ◽  
X Ray ◽  
Articular Process ◽  
Inner Surface ◽  
The Right ◽  
Anterior Root

✓ The authors describe transverse process hyperrotation and unilateral apophyseal joint subluxation as a novel mechanism of rotational vertebral artery (VA) occlusion. The patient, a 56-year-old man, complained of episodic bilateral blindness when rotating his head more than 90° to the right. Plain cervical x-ray films showed spondylotic osteophytes of the right C4–5 uncovertebral portion. Dynamic angiography revealed right VA occlusion at C4–5 and left VA occlusion at C1–2 with head rotation to the right. It was demonstrated on three-dimensional images constructed from computerized tomography scans that C-4 transverse process hyperrotation compressed the right VA against the apex of the C-5 subluxating superior articular process via the inner surface of the transverse process anterior root (processus costarius) rather than the osteophytes. It is also proposed that the true site of occlusion is different from that observed in angiographic studies.

Atlantoaxial stability in ossiculum terminale

2001 ◽  
Vol 95 (1) ◽  
pp. 119-121
Author(s):  
Cheng-Loong Liang ◽  
Chun-Chung Lui ◽  
Kang Lu ◽  
Tao-Chen Lee ◽  
Han-Jung Chen
Keyword(s):  
Cervical Spine ◽  
Magnetic Resonance ◽  
Three Dimensional ◽  
Odontoid Process ◽  
Magnetic Resonance Images ◽  
The Body ◽  
Content Type ◽  
Ossiculum Terminale ◽  
Atlantoaxial Stability ◽  
Fine Print

✓ The authors describe a patient with ossiculum terminale. Thin-section three-dimensional computerized tomography reconstructions, magnetic resonance images, and radiographs of the cervical spine were obtained to evaluate the atlantoaxial stability and structures of the ossiculum terminale. Bone had formed between the ossicles and the body of the odontoid process, and good atlantoaxial stability was clearly demonstrated.

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.

Spontaneous craniocervical osseous fusion caused by cervical dystonia

2001 ◽  
Vol 95 (1) ◽  
pp. 115-118 ◽  
Author(s):  
Ralf Weigel ◽  
Michael Rittmann ◽  
Joachim K. Krauss
Keyword(s):  
Cervical Dystonia ◽  
Three Dimensional ◽  
Sternocleidomastoid Muscle ◽  
Facet Joints ◽  
Content Type ◽  
History Of ◽  
Posterior Neck ◽  
Atlantoaxial Rotatory Fixation ◽  
The Right ◽  
Rotatory Fixation

✓ The authors report on a 31-year-old man with spontaneous craniocervical osseous fusion secondary to cervical dystonia (CD). After an 8-year history of severe CD, the patient developed a fixed rotation of his head to the right. Three-dimensional computerized tomography reconstructions revealed rotation and fixation of the occiput and C-1 relative to C-2, which was similar to that seen in atlantoaxial rotatory fixation. There was abnormal ossification of the odontoid facet joints and ligaments. Additional ossification was observed in the cervical soft tissue bridging the lateral mass of C-1 and the occiput. The patient underwent partial myectomy of the dystonic left sternocleidomastoid muscle and selective posterior ramisectomy of the right posterior neck muscles; postoperatively he experienced relief of his neck pain. In patients with CD refractory to conservative treatment, the appropriate timing of surgical treatment is important.

Vascular decompression of a vertebral artery loop producing cervical radiculopathy

1998 ◽  
Vol 89 (3) ◽  
pp. 485-488 ◽  
Author(s):  
Paul W. Detwiler ◽  
Randall W. Porter ◽  
Timothy R. Harrington ◽  
Volker K. H. Sonntag ◽  
Robert F. Spetzler
Keyword(s):  
Vertebral Artery ◽  
Nerve Root ◽  
Cervical Radiculopathy ◽  
Vascular Structure ◽  
Loop Formation ◽  
Content Type ◽  
History Of ◽  
Radicular Symptoms ◽  
The Right ◽  
Vascular Decompression

✓ Vertebral artery tortuosity and loop formation are rare causes of cervical radiculopathy. The authors present the case of a 70-year-old man with 9 years of progressive right-sided cervical and scapular pain but no history of trauma. Computerized tomography myelography and magnetic resonance imaging revealed an ovoid mass in the right C3–4 intervertebral foramen. The patient underwent a right C-3 and C-4 hemilaminectomy and a complete C3–4 facetectomy. A pulsatile vascular structure was found compressing the right C-4 nerve root. The bone overlying the vascular structure was removed, producing decompression of the nerve root. Immediate postoperative angiography showed that this lesion was a focal vertebral artery loop. The patient's symptoms resolved after surgery, supporting the use of vascular decompression of a cervical nerve root compressed by a vertebral artery loop for the relief of radicular symptoms.

scholarly journals A Quantitative Comparison of the Vertebral Artery and Transverse Foramen Using CT Angiography

2012 ◽  
Vol 8 (4) ◽  
pp. 259 ◽  
Author(s):  
Chulho Kim ◽  
Seung-Hoon Lee ◽  
Sang Soon Park ◽  
Beom Joon Kim ◽  
Wi-Sun Ryu ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Ct Angiography ◽  
Quantitative Comparison ◽  
Transverse Foramen

Three-dimensional computerized tomography angiography in patients with hyperacute intracerebral hemorrhage

1999 ◽  
Vol 91 (3) ◽  
pp. 424-431 ◽  
Author(s):  
Yasuo Murai ◽  
Ryo Takagi ◽  
Yukio Ikeda ◽  
Yasuhiro Yamamoto ◽  
Akira Teramoto
Keyword(s):  
Intracerebral Hemorrhage ◽  
Ct Angiography ◽  
Computerized Tomography ◽  
Three Dimensional ◽  
Ct Scanning ◽  
3D Ct ◽  
Content Type ◽  
Hematoma Enlargement ◽  
3D Ct Angiography ◽  
Fine Print

Object. The authors confirm the usefulness of extravasation detected on three-dimensional computerized tomography (3D-CT) angiography in the diagnosis of continued hemorrhage and establishment of its cause in patients with acute intracerebral hemorrhage (ICH).Methods. Thirty-one patients with acute ICH in whom noncontrast and 3D-CT angiography had been performed within 12 hours of the onset of hemorrhage and in whom conventional cerebral angiographic studies were obtained during the chronic stage were prospectively studied. Noncontrast CT scanning was repeated within 24 hours of the onset of ICH to evaluate hematoma enlargement.Findings indicating extravasation on 3D-CT angiography, including any abnormal area of high density on helical CT scanning, were observed in five patients; three of these demonstrated hematoma enlargement on follow-up CT studies. Thus, specificity was 60% (three correct predictions among five positives) and sensitivity was 100% (19 correct predictions among 19 negatives). Evidence of extravasation on 3D-CT angiography indicates that there is persistent hemorrhage and correlates with enlargement of the hematoma.Regarding the cause of hemorrhage, five cerebral aneurysms were visualized in four patients, and two diagnoses of moyamoya disease and one of unilateral moyamoya phenomenon were made with the aid of 3D-CT angiography. Emergency surgery was performed without conventional angiography in one patient who had an aneurysm, and it was clipped successfully.Conclusions. Overall, 3D-CT angiography was found to be valuable in the diagnosis of the cause of hemorrhage and in the detection of persistent hemorrhage in patients with acute ICH.

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