Document Detail

Bilateral inverted vertebral arteries (V3 segment) in a case of congenital atlantoaxial dislocation: Distinct entity or a lateral variant of persistent first intersegmental artery?
MedLine Citation:
PMID:  25024882     Owner:  NLM     Status:  PubMed-not-MEDLINE    
BACKGROUND: Anomalous vertebral arteries (VAs), commonly involving the persistent first intersegmental artery (FIA), are often seen with congenital atlantoaxial dislocations (AAD). Here we describe an unusual variant consisting of bilateral VAs with normal loops but passing below the C1 (inverted VA) arch, distinctly different from the FIA.
CASE DESCRIPTION: A 9-year-old boy presented with a spastic quadriparesis. Preoperative radiographic studies showed an irreducible AAD with an occipitalized CO-C1 and C2-3 fusion. Although both VAs exhibited proximal and distal loops like normal VA, the distal loops did not pass through the C1 transverse foramina and coursed inferior to the C1 arch instead. With this critical preoperative information, both VAs could be better safeguarded during dissection of the C1-2 facets.
CONCLUSION: In the case presented, although the course of the inverted VAs is similar, the norm, they coursed inferior to both C1 arches. Careful evaluation of the preoperative radiological studies allowed for careful dissection of the inverted VA (horizontal loop) while opening the C1-2 joint for subsequent alignment (e.g. reduction) and bony fusion. This information also facilitates safer insertion of lateral mass screws (e.g. choosing the appropriate C1 screw length to gain adequate bony purchase without compromising anomalous VA).
Pravin Salunke; Sushanta K Sahoo; Mandeep S Ghuman
Publication Detail:
Type:  Journal Article     Date:  2014-05-31
Journal Detail:
Title:  Surgical neurology international     Volume:  5     ISSN:  2229-5097     ISO Abbreviation:  Surg Neurol Int     Publication Date:  2014  
Date Detail:
Created Date:  2014-07-15     Completed Date:  2014-07-15     Revised Date:  2014-07-17    
Medline Journal Info:
Nlm Unique ID:  101535836     Medline TA:  Surg Neurol Int     Country:  India    
Other Details:
Languages:  eng     Pagination:  82     Citation Subset:  -    
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