Surgical management of cervical radiculopathy caused by redundant vertebral artery loop

2012 ◽  
Vol 17 (4) ◽  
pp. 337-341 ◽  
Author(s):  
Ziad A. Hage ◽  
Sepideh Amin-Hanjani ◽  
Dennis Wen ◽  
Fady T. Charbel
Keyword(s):  
Vertebral Artery ◽  
Nerve Root ◽  
Cervical Radiculopathy ◽  
Surgical Approaches ◽  
Anterolateral Approach ◽  
Transverse Foramen ◽  
History Of ◽  
The Right ◽  
Almost All ◽  
Vascular Decompression

In this article, the authors describe the case of a 27-year-old female presenting with a 2-year history of neck pain and radiculopathy attributable to compression of the right C-7 nerve root by tortuosity of the vertebral artery at the level of the C6–7 cervical foramina. An anterolateral approach to the transverse foramen was used to perform a vascular decompression to decompress the nerve root. The procedure was uneventful, and the patient woke up with almost all of her symptoms resolved. The authors also include a literature review of techniques performed in this setting, showing that multiple surgical approaches can be used and should be tailored to the patient symptoms and lesion characteristics.

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 Anterior artery release, distraction and fusion (ARDF) for radiculopathy caused by a vertebral artery loop

2021 ◽  
Author(s):  
Mazda Farshad ◽  
José Miguel Spirig ◽  
Marco D. Burkhard
Keyword(s):  
Vertebral Artery ◽  
Nerve Root ◽  
Cervical Radiculopathy ◽  
Loop Formation ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
Surgical Strategies ◽  
History Of ◽  
The Right ◽  
Neurovascular Decompression

Abstract Background Anomalous vertebral artery (VA) with loop formation is a rare cause of cervical nerve root compression. Various techniques with anterior and posterior approaches have been described for surgical treatment once conservative treatments fail. We herein present a case treated with the new technique of anterior release, distraction and fusion (ARDF) and further provide an updated review of surgically managed VA loops in the subaxial spine. Case description A 76-year-old female complained of a 6-year history of pulsating, shooting pain in her right arm to the thumb. After obtaining repeated MRI, the VA loop compressing the right-sided C6-nerve root was detected. A neurovascular decompression through ARDF which led to an indirect loop straightening was performed. The patient immediately improved after surgery and remained pain-free 1 year postoperative. Conclusion Neural irritation due to VA loop formation is a rare cause of cervical radiculopathy. While various surgical strategies have been described, we believe that anterior and anterolateral approaches are the safest to yield neurovascular decompression. We described and documented ARDF (anterior VA release, intervertebral distraction and fusion) on a patient case. Level of evidence II (Diagnostic: individual cross-sectional studies with consistently applied reference standard and blinding).

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.

Bow Hunter's Syndrome: Complete Microsurgical Decompression of Vertebral Artery by Far Lateral Retrocondylar Approach: 3-Dimensional Operative Video

2019 ◽  
Author(s):  
Qazi Zeeshan ◽  
Juan P Carrasco Hernandez ◽  
Laligam N Sekhar
Keyword(s):  
Vertebral Artery ◽  
Nerve Root ◽  
Dynamic Compression ◽  
Skin Incision ◽  
Left Vertebral Artery ◽  
Occipital Condyle ◽  
Cerebral Angiogram ◽  
Microsurgical Decompression ◽  
C2 Nerve Root ◽  
The Right

Abstract This 50-yr-old man had a 15-yr history of presyncopal episodes that were precipitated by turning his head to the right, and had worsened recently. Cerebral angiogram demonstrated complete cessation of anterograde flow in left vertebral artery (VA) at the level of the C1 sulcus arteriosus while turning head to right, indicating dynamic compression at the C1 level.  Patient underwent left extreme lateral retrocondylar approach, partial C1 laminectomy and opening of the C1 foramen with complete microsurgical decompression of the VA. After skin incision, meticulous muscle dissection was performed and superior and inferior oblique muscles were disconnected from the tubercle of C1. The VA was exposed, and three areas of constriction were visible, first at the atlanto-occipital membrane laterally; second, located more medially as the artery curved around the occipital condyle to enter the posterior fossa; and third, located anterior to C2 nerve root. The artery was dissected from all the surrounding tissues, preserving the C2 nerve root, and the Cl foramen was opened completely. The Cl lamina was also partially resected and grooved to allow free placement of the VA. The VA was also decompressed near the C2 foramen. Postoperative computed tomography angiogram of the head and neck showed complete decompression of VA. The patient had no episodes of presyncope or dizziness while turning head to right and his mRs was 0 at 8 mo follow up.  This 3D video shows the technical nuances of decompression of V3 segment of VA in bow hunters's syndrome.  Informed consent was obtained from the patient prior to the surgery that included videotaping of the procedure and its distribution for educational purposes. All relevant patient identifiers have also been removed from the video and accompanying radiology slides.

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.

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.

Traumatic C6–7 subluxation with anomalous course of vertebral arteries treated with pedicle screw/rod fixation

2007 ◽  
Vol 7 (1) ◽  
pp. 65-70 ◽  
Author(s):  
Masashi Yamazaki ◽  
Takana Koshi ◽  
Chikato Mannoji ◽  
Akihiko Okawa ◽  
Masao Koda
Keyword(s):  
Pedicle Screw ◽  
Nerve Root ◽  
Deformity Correction ◽  
Transverse Foramen ◽  
Cervical Spine Injuries ◽  
Vertebral Arteries ◽  
Rod System ◽  
Bone Fragments ◽  
Cervical Injuries ◽  
The Right

✓ The authors report the case of a 62-year-old woman who suffered an accidental fall and complained of severe neck pain and right C-7 radiculopathy. A right C6–7 facet fracture–subluxation was diagnosed. Bone fragments impinged on the right C-7 nerve root at the neural foramen. The bilateral vertebral arteries (VAs) ascended at the anterior aspect of C-6 and C-5 and entered the transverse foramen at the C-4 level. Based on findings of anomalous VAs, the authors applied a pedicle screw (PS)/rod system to effect surgical correction of the deformity. Intraoperatively, they successfully performed reduction of the subluxation, decompression of the impinged nerve root, and minimum single-segment fusion involving the placement of a PS/rod system. After surgery, the patient's neurological deficit dramatically improved and spinal fusion was completed without any loss of deformity correction. Prior to surgery for cervical injuries, the possible presence of an abnormal VA course should be considered. Preoperative detection of anomalous VAs will affect decisions on the appropriate corrective surgery option in cases of cervical spine injuries.

Microsurgical Cervical Nerve Root Decompression by Anterolateral Approach

2006 ◽  
Vol 58 (suppl_1) ◽  
pp. ONS-103-ONS-107 ◽  
Author(s):  
Michaël Bruneau ◽  
Jan Frédérick Cornelius ◽  
Bernard George
Keyword(s):  
Minimally Invasive ◽  
Nerve Root ◽  
Cervical Radiculopathy ◽  
Minimally Invasive Technique ◽  
Invasive Technique ◽  
Anterolateral Approach ◽  
Cervical Nerve Root ◽  
Cervical Nerve ◽  
Neurosurgical Procedure ◽  
Nerve Root Decompression

Abstract OBJECTIVE: Cervical radiculopathy caused by a posterolateral soft disc herniation or spondylosis is a common pathology. METHODS: Decompression of a stressed cervical nerve root is a routine neurosurgical procedure. Most of the time it is achieved through an anterior approach and, less frequently, through a posterior approach in specific indications. RESULTS: According to the principles that an anterolateral compression must directly be reached and that working in the vicinity of the vertebral artery is safe under visual control, we developed the anterolateral approach to the cervical intervertebral foramen and the nerve root using a minimally invasive technique to remove the offending process. CONCLUSION: Microsurgical cervical nerve root decompression by anterolateral approach is a minimally invasive technique, permitting one to remove the offending process staightforwardly. The disc and bone resections are minimal. This method avoids osteoarthrodesis or arthroplasty with disc prosthesis. This technique is efficient with good results and low morbidity.

Anterolateral Approach To The V1 Segment Of The Vertebral Artery

2006 ◽  
Vol 58 (suppl_4) ◽  
pp. ONS-215-ONS-219 ◽  
Author(s):  
Michaël Bruneau ◽  
Jan Frédérick Cornelius ◽  
Bernard George
Keyword(s):  
Surgical Technique ◽  
Vertebral Artery ◽  
Subclavian Artery ◽  
Lateral Approach ◽  
Anterolateral Approach ◽  
Intervertebral Disc Space ◽  
Disc Space ◽  
Transverse Foramen ◽  
And Control ◽  
V1 Segment

Abstract Objective: We describe the normal anatomy, variations, and the surgical technique to expose and control the V1 segment of the vertebral artery (VA). Methods: The VA V1 segment extends classically from the subclavian artery to the C6 transverse foramen. It courses obliquely upwards and posteriorly in the cervical fat tissue, at a distance of 5 to 10 mm from the C7 vertebral body. Along its course, the VA V1 segment is crossed by the inferior thyroid artery, the thoracic duct, and the sympathetic chain. For neurosurgeons, the safest approach is to expose the distal part of the V1 segment at the C6 transverse foramen level through an antero-lateral approach. Otherwise, direct exposure of the subclavian artery requires vascular surgery expertise. Results: Surgical exposure of the VA V1 segment can be indicated on approaching the C6–C7 intervertebral disc space for degenerative disease or on treating tumoral processes in its vicinity. With developments of endovascular techniques, revascularization procedures are more rarely indicated nowadays. Conclusion: Perfect knowledge of the anatomy and of the surgical technique permits a safe exposure and control of the VA V1 segment.

scholarly journals Dimensions and Anatomical Variants of the Foramen Transversarium of Typical Cervical Vertebrae

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Santosh Kaur Sangari ◽  
Paul-Michel Dossous ◽  
Thomas Heineman ◽  
Estomih Phillip Mtui
Keyword(s):  
Vertebral Artery ◽  
Thrombus Formation ◽  
Cervical Vertebrae ◽  
Uncinate Process ◽  
Vertebrobasilar Insufficiency ◽  
Transverse Foramen ◽  
Medial Margin ◽  
Significant Difference ◽  
The Mean ◽  
The Right

The study was conducted on random sample of seventy-one dried, typical cervical vertebrae (C3–C6). The data on the age, sex, and built was not available. Using vernier calipers with 0.01 mm accuracy, the anteroposterior and transverse diameters of transverse foramina and their distance from the medial margin of the uncinate process were measured bilaterally. The mean diameter of the right/left transverse foramen varied from 2.54 mm to 7.79 mm (mean = 5.55 ± 0.87 mm) and from 2.65 mm to 7.35 mm (mean = 5.48 ± 0.77 mm), respectively. The transverse foramen was less than 3.5 mm in three vertebrae on the right and two on the left. The osteocytes observed in 21.3% of specimens and the narrow transverse foramen may place patients at risk for vertebrobasilar insufficiency or thrombus formation. The mean distance of the transverse foramen from the medial margin of uncinate process is an important landmark to avoid vertebral artery laceration and was 5.0 ± 0.87 mm (range: 3.5–7.9 mm) on the right and 5.0 ± 1.0 mm (range: 3.2–7.7 mm) on the left side. No statistically significant difference was observed between the right and left sides. The accessory transverse foramina seen in 24% of vertebrae suggest duplications or fenestrations in the vertebral artery.

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