The Tortuous Vertebral Artery Compressing the Cervical Nerve Root : An Autopsy Case Report

Abstract OBJECTIVE AND IMPORTANCE: Extradural hemangioblastomas account for 8 to 12% of all spinal hemangioblastomas. Among them, intra-extradural forms with a dumbbell extension are extremely rare. We report a case of intra-extradural hemangioblastoma involving the C6 cervical nerve root. CLINICAL PRESENTATION: The patient was a 31-year-old woman presenting with signs of myelopathy and C6 radiculopathy on the right side. A computed tomographic scan and magnetic resonance imaging demonstrated a dumbbell tumor that had developed through the C5–C6 intervertebral foramen. Angiography revealed a well-circumscribed mass with feeders from the vertebral artery and the deep cervical artery. INTERVENTION: The tumor was totally removed through the lateral approach, with control of the vertebral artery and sacrifice of the C6 cervical nerve root. Limited bone drilling to enlarge the foramen permitted us to reach and resect the intradural component. Histopathological examination confirmed the diagnosis of hemangioblastoma. Follow-up was uneventful. CONCLUSION: This is the sixth reported case of a cervical dumbbell hemangioblastoma investigated by computed tomographic scanning and MRI but the first one resected via the lateral approach. The lateral approach seems appropriate for surgical resection because it provides primary control of the vascular feeders and access to the extradural and intradural components.

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Management Approach of Penetrating Vertebral Artery Injury with Concomitant Cervical Nerve Root Injury in Regional Hospital: Report of Two Cases

Journal of Orthopaedics Trauma and Rehabilitation ◽

10.1016/j.jotr.2017.09.002 ◽

2018 ◽

Vol 25 (1) ◽

pp. 5-10

Author(s):

Lam Yuk-Yu ◽

Tsui Hon-For ◽

Wong Hok-Leung ◽

Chow Yuk-Yin

Keyword(s):

Vertebral Artery ◽

Nerve Root ◽

Endovascular Intervention ◽

Vertebral Artery Injury ◽

Management Approach ◽

Cervical Nerve Root ◽

Cervical Nerve ◽

Nerve Root Injury ◽

Artery Injury ◽

Root Injury

Penetrating vertebral artery injury is uncommon yet potentially fatal. We present two cases of penetrating vertebral artery injury with concomitant cervical nerve root injury managed in our centre. The first case was a young gentleman who suffered from neck injury by broken metal fragment. Cervical nerve root injury was suspected preoperatively. Massive bleeding from vertebral artery was encountered during wound exploration. It was managed by ligation, followed by retrograde endovascular embolisation. The second case was a young lady being assaulted with knife and fork over the neck. She was also suspected to have cervical nerve root injury preoperatively. Vascular control of vertebral artery was achieved with endovascular intervention. Subsequent operation for foreign body removal and nerve root repair was performed with minimal bleeding intraoperatively. Management approach of penetrating vertebral artery injury with concomitant cervical nerve root injury and the role of endovascular intervention were discussed.

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Can we Rotate the Head Safely During Cervical Nerve Root Injection?

Indian Journal of Musculoskeletal Radiology ◽

10.25259/ijmsr_8_2020 ◽

2020 ◽

Vol 2 ◽

pp. 32-35

Author(s):

Aamer Iqbal ◽

Emer McLoughlin ◽

Steven James ◽

Rajesh Botchu

Keyword(s):

Vertebral Artery ◽

Nerve Root ◽

Head Rotation ◽

Cross Sectional Area ◽

Neutral Position ◽

Sectional Area ◽

Cervical Nerve Root ◽

Cervical Nerve ◽

Cross Sectional ◽

Epidural Injections

Objectives: Trans-foraminal epidural injections have been used successfully to aid in the management of cervicobrachialagia. The aim of this study was to assess the cross sectional area of the vertebral artery during transforaminal cervical nerve root injections (TFCNRI) when the head is typically rotated and to compare with the neutral position cross sectional area. We hypothesize that head rotation does not lead to a change of vertebral artery calibre at the neural foramen, thus this technique can be performed relatively safely during TFCNRI. Material and Methods: A pilot study involving a retrospective review of 16 computed tomography guided TFNRI was performed and cross sectional area of vertebral artery with head tilted and head in neutral position was performed. Results: There was no correlation between the degree of head rotation and change in the area of the ipsilateral or contralateral vertebral artery. Conclusion: We suggest that head can safely be rotated to varied degrees while performing TFCNRI.

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