scholarly journals Can the transverse foramen/vertebral artery ratio of double transverse foramen subjects be a risk for vertebrobasilar transient ischemic attacks?

2018 ◽  
Vol 233 (3) ◽  
pp. 341-346
Author(s):  
Juan A. Sanchis-Gimeno ◽  
Esther Blanco-Perez ◽  
Susanna Llido ◽  
Marcelino Perez-Bermejo ◽  
Shahed Nalla ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Transient Ischemic Attacks ◽  
Transverse Foramen

Microsurgical Endarterectomy of the Intracranial Vertebral Artery for Vertebrobasilar Transient Ischemic Attacks

Neurosurgery ◽  
1981 ◽  
Vol 8 (1) ◽  
pp. 56-59 ◽  
Author(s):  
George S. Allen ◽  
Ronald J. Cohen ◽  
Thomas J. Preziosi
Keyword(s):  
Vertebral Artery ◽  
Brain Stem ◽  
Antiplatelet Therapy ◽  
Atherosclerotic Plaque ◽  
Basilar Artery ◽  
Neurological Deficit ◽  
Operating Microscope ◽  
Transient Ischemic Attacks

Abstract Two patients who had typical vertebrobasilar transient ischemic attacks (TIAs) that were refractory to anticoagulation with dicumarol and to antiplatelet therapy with aspirin and/or dipyridamole are described. Angiography revealed in both patients a stenotic atherosclerotic plaque of the intracranial vertebral artery between the posterior and anterior inferior cerebellar arteries. At operation, the first patient had an atherosclerotic plaque extending into the basilar artery, and no endarterectomy was attempted. The second patient had a 1-cm localized plaque that was removed successfully from the vertebral artery. Neither patient sustained a neurological deficit as a result of the operation. The patient whose plaque was not removed at operation continues to have vertebrobasilar TIAs and suffered a brain stem stroke 2 weeks after operation. The patient whose plaque was removed at operation continues to be free of TIAs 8 months later, and angiography performed 3 months after operation showed a widely patent vertebral artery. A portion of the intracranial vertebral artery has now been shown to be accessible to endarterectomy using the operating microscope. Angiography is helpful in determining this accessibility preoperatively.

Mild trauma causing cervical fracture through transverse foramen leading to a vertebral arteriovenous fistula

2021 ◽  
Vol 14 (6) ◽  
pp. e241735
Author(s):  
Mikkel Schou Andersen ◽  
Willy Krone ◽  
Sune Munthe
Keyword(s):  
Vertebral Artery ◽  
Arteriovenous Fistula ◽  
Vertebral Artery Dissection ◽  
Artery Dissection ◽  
Digital Subtraction ◽  
Trauma Mechanism ◽  
Transverse Foramen ◽  
Cervical Fractures ◽  
Vertebral Arteriovenous Fistula ◽  
Ct Angiogram

Vertebral arteriovenous fistula (vAVF) is an uncommon vascular disease defined as abnormal connections between the vertebral artery or its branches extracranially with nearby venous structures. This case report outlines the case of a man in his late 70s presenting with C1–C3 fractures after a mild trauma falling down a small staircase. CT angiogram (CTA) gave suspicion of vertebral artery dissection and pseudoaneurysm; however, digital subtraction angiography revealed a fracture-induced vAVF successfully treated endovascularly with coils. In conclusion, cervical fractures involving the transverse foramen regardless of trauma mechanism should result in a CTA. Endovascular treatment with ipsilateral vertebral artery closure is preferred due to its feasibility and safety.

scholarly journals Cervical Vertebral Artery to Facial Branch External Carotid Artery Bypass: 2-Dimensional Operative Video

2020 ◽  
Author(s):  
Benjamin K Hendricks ◽  
Robert F Spetzler
Keyword(s):  
Carotid Artery ◽  
Vertebral Artery ◽  
Artery Bypass ◽  
Video Recording ◽  
Distal Segment ◽  
External Carotid Artery ◽  
External Carotid ◽  
Transverse Foramen ◽  
Institutional Review ◽  
V1 Segment

Abstract Posterior circulation ischemia often presents with dizziness, ataxia, visual disturbances, or motor-sensory deficits. The vertebral artery stenosis most frequently involves the V1 segment proximal to the foraminal segment. This patient demonstrated critical stenosis of the left V1 segment of the vertebral artery related to atherosclerotic disease. A left cervical dissection was performed, and the cervical transverse foramen was opened to permit exposure of the vertebral artery in the V2 segment. The vertebral artery was proximally occluded and transected. An endarterectomy was performed, and an end-to-end anastomosis of the facial branch of the external carotid artery to the distal segment of the transected vertebral artery was completed. Indocyanine green angiography was used to confirm patency of the anastomosis. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.

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

scholarly journals Extracranial Vertebral Artery Aneurysm Presenting as a Chronic Cervical Mass Lesion

2010 ◽  
Vol 2010 ◽  
pp. 1-3 ◽  
Author(s):  
Lampis C. Stavrinou ◽  
George Stranjalis ◽  
Pantelis C. Stavrinou ◽  
N. Bontozoglou ◽  
Damianos E. Sakas
Keyword(s):  
Vertebral Artery ◽  
Artery Aneurysm ◽  
Clinical History ◽  
Cervical Radiculopathy ◽  
Artery Occlusion ◽  
Transverse Foramen ◽  
Artery Pseudoaneurysm ◽  
History Of ◽  
Extracranial Vertebral Artery ◽  
Cervical Root

Background. Aneurysms of the extracranial vertebral artery are rare and can provide a diagnostic and therapeutic challenge.Methods. We reviewed the clinical history of a patient presenting with cervical radiculopathy, who harboured an extracranial vertebral artery aneurysm eroding the cervical spine.Results. CT Angiography and MR Angiography set the diagnosis, by revealing a left C5-C6 vertebral artery aneurysm with cervical root impingement. Bony reconstruction depicted enlargement of the C6 transverse foramen and a marked enlargement of the C6-C7 intravertebral foramen. The lesion was treated by intravascular proximal vertebral artery occlusion.Conclusions. Extracranial vertebral artery aneurysms require a high index of clinical suspicion. This is the first report of a vertebral artery pseudoaneurysm presenting with bony erosion, which supports a less minacious portrayal of vertebral artery aneurysms.

Venous organization in the transverse foramen: dissection, histology, and magnetic resonance imaging

2015 ◽  
Vol 123 (1) ◽  
pp. 118-125 ◽  
Author(s):  
Elsa Magro ◽  
Jean-Christophe Gentric ◽  
Matthieu Talagas ◽  
Zarrin Alavi ◽  
Michel Nonent ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Vertebral Artery Dissection ◽  
Anatomical Study ◽  
Venous System ◽  
Surgical Approaches ◽  
Artery Dissection ◽  
Transverse Foramen ◽  
Radiological Study ◽  
Precise Knowledge ◽  
Mri Study

OBJECT The anatomical arrangement of the venous system within the transverse foramen is controversial; there is disagreement whether the anatomy consists of a single vertebral vein or a confluence of venous plexus. Precise knowledge of this arrangement is necessary in imaging when vertebral artery dissection is suspected, as well as in surgical approaches for the cervical spine. This study aimed to better explain anatomical organization of the venous system within the transverse foramen according to the Trolard hypothesis of a transverse vertebral sinus. METHODS This was an anatomical and radiological study. For the anatomical study, 10 specimens were analyzed after vascular injection. After dissection, histological cuts were prepared. For the radiological study, a high-resolution MRI study with 2D time-of-flight segment MR venography sequences was performed on 10 healthy volunteers. RESULTS Vertebral veins are arranged in a plexiform manner within the transverse canal. This arrangement begins at the upper part of the transverse canal before the vertebral vein turns into a single vein along with the vertebral artery running from the transverse foramen of the C-6. This venous system runs somewhat ventrolaterally to the vertebral artery. In most cases, this arrangement is symmetrical and facilitates radiological readings. The anastomoses between vertebral veins and ventral longitudinal veins are uniform and arranged segmentally at each vertebra. CONCLUSIONS These findings confirm recent or previous anatomical descriptions and invalidate others. It is hard to come up with a common description of the arrangement of vertebral veins. The authors suggest providing clinicians as well as anatomists with a well-detailed description of components essential to the understanding of this organization.

The vertebral artery and the cervical pedicle: morphometric analysis of a critical neighborhood

2010 ◽  
Vol 13 (1) ◽  
pp. 52-60 ◽  
Author(s):  
Andre Tomasino ◽  
Karishma Parikh ◽  
Heiko Koller ◽  
Walter Zink ◽  
A. John Tsiouris ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Ct Angiography ◽  
Posterior Instrumentation ◽  
Pedicle Screws ◽  
Safe Zone ◽  
Transverse Foramen ◽  
Sagittal Diameter ◽  
Entry Points ◽  
Cervical Pedicle ◽  
The Mean

Object The purpose of this retrospective study was to quantify the anatomical relationship between the vertebral artery (VA), the cervical pedicle, and its surrounding structures, including the incidence of irregularities. Additionally, data delineating a “safe zone,” and these data's application during instrumentation with transpedicular cervical screw fixation were considered. The anatomical proximity of the VA to the cervical pedicle prevents spine surgeons from preferring cervical pedicle screws (CPSs) over lateral mass screws at levels C3–6. Accurate placement of CPSs is often difficult to determine, because this definition can vary between 1 and 4 mm of lateral “noncritical” and “critical” pedicle breaches. No previous study in a western population has investigated the VA's proximity to the cervical pedicle, its percentage of occupancy in the transverse foramen (TF), and the incidence of irregular VA pathways. Methods One hundred twenty-seven consecutive patients who underwent CT angiography of the neck were enrolled in this study. The measurements included the following: medial pedicle border to VA; lateral pedicle border to VA; pedicle diameter (PD); sagittal diameter of the VA; coronal diameter of the VA; sagittal diameter of the TF; and coronal diameter of the TF. The cross-sections of the VA and the TF were measured to determine the occupation ratio of the VA. In addition, a safe zone was defined based on all lateral pedicle border to VA measurements in which the VA was within the TF. The level of entry of the VA into the TF as well as irregularities of the VA and the cervical pedicles were recorded. Results Vertebral artery dominance on the left side was seen in 69.3% of cases. The mean PD increased from 4.9 to 6.5 mm (from C-3 to C-7, respectively). Statistically significantly bigger PDs were seen in males. The mean PD at C-2 was 5.6 mm. Entry of the VA at C-6 was seen in approximately 80% of cases. The TF occupation ratio of the VA was found to be the greatest in C-4 and C-7 (37.1 and 74.2%, respectively). The safe zone increased from C-2 to C-6 (1.1 to 1.7 mm, respectively), but was only 0.65 mm at C-7. In 23.6% of cases, an irregular pathway of the VA or irregular anatomy of a cervical pedicle was seen, with the highest incidence of irregularities found at C-2. Conclusions Computed tomography angiography is a valuable tool that can help determine the relationships between cervical pedicles and the VA as well as irregular VA pathways. Pedicle diameter, safe zone, and occupational ratio of the VA in the foramen determine the risk associated with instrumentation and should be assessed individually. Based on the authors' measurements, C-4 and C-7 can be considered critical levels for CPS placement. Because of this and the high incidence of irregular VA pathways and different entry points, it may be helpful to review neck CT angiography studies before considering posterior instrumentation procedures in the cervical spine.

scholarly journals A Five-Vessel Aortic Arch with an Anomalous Origin of Both Vertebral Arteries and an Aberrant Right Subclavian Artery

2004 ◽  
Vol 10 (4) ◽  
pp. 309-314 ◽  
Author(s):  
P.A. Brouwer ◽  
M.P.S. Souza ◽  
R. Agid ◽  
K.G. terBrugge
Keyword(s):  
Carotid Artery ◽  
Vertebral Artery ◽  
Aortic Arch ◽  
Subclavian Artery ◽  
Common Carotid Artery ◽  
Anomalous Origin ◽  
Aberrant Right Subclavian Artery ◽  
Left Vertebral Artery ◽  
Transverse Foramen ◽  
The Right

In this case presentation we describe a patient with an anomalous origin of the right vertebral artery arising from the right common carotid artery in combination with an aberrant right subclavian artery and a left vertebral artery originating from the arch between the left common carotid artery and left subclavian artery. Hence there were five vessels originating from the aortic arch. The possible embryological mechanism as well as a postulation on the importance of the level of entrance of the vertebral artery in the cervical transverse foramen is discussed.

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