scholarly journals Asymptomatic rotational vertebral artery compression in a child due to head positioning for cranial surgery: illustrative case

2021 ◽  
Vol 1 (3) ◽  
Author(s):  
M. Travis Caton ◽  
Kazim Narsinh ◽  
Amanda Baker ◽  
Adib A. Abla ◽  
Jarod L. Roland ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Patient Positioning ◽  
Clinical History ◽  
Posterior Circulation ◽  
Illustrative Case ◽  
Intraoperative Angiography ◽  
Head Turning ◽  
Cranial Surgery ◽  
Signal Abnormality ◽  
Head Positioning

BACKGROUNDThe authors recently reported a series of children with vertebral artery (VA) compression during head turning who presented with recurrent posterior circulation stroke. Whether VA compression occurs during head positioning for cranial surgery is unknown.OBSERVATIONSThe authors report a case of a child with incidental rotational occlusion of the VA observed during surgical head positioning for treatment of an intracranial arteriovenous fistula. Intraoperative angiography showed dynamic V3 occlusion at the level of C2 with distal reconstitution via a muscular branch “jump” collateral, supplying reduced flow to the V4 segment. She had no clinical history or imaging suggesting acute or prior stroke. Sequential postoperative magnetic resonance imaging scans demonstrated signal abnormality of the left rectus capitus muscle, suggesting ischemic edema.LESSONSThis report demonstrates that rotational VA compression during neurosurgical head positioning can occur in children but may be asymptomatic due to the presence of muscular VA–VA “jump” collaterals and contralateral VA flow. Although unilateral VA compression may be tolerated by children with codominant VAs, diligence when rotating the head away from a dominant VA is prudent during patient positioning to avoid posterior circulation ischemia or thromboembolism.

scholarly journals Rotational vertebrobasilar insufficiency due to compression of a persistent first intersegmental vertebral artery variant: case report

2017 ◽  
Vol 26 (2) ◽  
pp. 199-202 ◽  
Author(s):  
Vivek P. Buch ◽  
Peter J. Madsen ◽  
Kerry A. Vaughan ◽  
Paul F. Koch ◽  
David K. Kung ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Dynamic Compression ◽  
Posterior Circulation ◽  
Posterior Arch ◽  
Vertebrobasilar Insufficiency ◽  
Digital Subtraction ◽  
Head Turning ◽  
Atlantoaxial Fusion ◽  
Episodic Vertigo ◽  
Hunter's Syndrome

Rotational vertebrobasilar insufficiency, or bow hunter's syndrome, is a rare cause of posterior circulation ischemia, which, following rotation of the head, results in episodic vertigo, dizziness, nystagmus, or syncope. While typically caused by dynamic occlusion of the vertebral artery in its V2 and V3 segments, the authors here describe a patient with dynamic occlusion of the vertebral artery secondary to a persistent first intersegmental artery, a rare variant course of the vertebral artery. In this case the vertebral artery coursed under rather than over the posterior arch of the C-1. This patient was also found to have incomplete development of the posterior arch of C-1, as is often seen with this variant. The patient underwent dynamic digital subtraction angiography, which demonstrated occlusion at the variant vertebral artery with head turning. He was then taken for decompression of the vertebral artery through removal of the incomplete arch of C-1 that was causing the dynamic compression. After surgery the patient had a complete resolution of symptoms. In this report, the authors present the details of this case, describe the anatomical variants involved, and provide a discussion regarding the need for atlantoaxial fusion in these patients.

Rotational Vertebrobasilar Ischemia: Hemodynamic Assessment and Surgical Treatment

Neurosurgery ◽  
2005 ◽  
Vol 56 (1) ◽  
pp. 36-45 ◽  
Author(s):  
Marcelo D. Vilela ◽  
Robert Goodkin ◽  
David A. Lundin ◽  
David W. Newell
Keyword(s):  
Surgical Treatment ◽  
Vertebral Artery ◽  
Transcranial Doppler ◽  
Posterior Circulation ◽  
Long Term Results ◽  
Vertebrobasilar Insufficiency ◽  
Head Turning ◽  
Vertebrobasilar Ischemia ◽  
Hemodynamic Assessment ◽  
Vertebral Artery Compression

Abstract OBJECTIVE: Rotational vertebrobasilar insufficiency is a severe and incapacitating condition. Proper investigation and management are essential to reestablish normal posterior circulation hemodynamics, improve symptoms, and prevent stroke. We present a series of 10 patients with rotational vertebrobasilar ischemia who were treated surgically and emphasize the importance of transcranial Doppler in the diagnosis and management of this condition. METHODS: All patients presented with symptoms of vertebrobasilar insufficiency induced by head turning. Transcranial Doppler documented a significant decrease in the posterior cerebral artery velocities during head turning that correlated with the symptoms in all patients. A dynamic cerebral angiogram was performed to demonstrate the site and extent of vertebral artery compression. RESULTS: The surgical technique performed was tailored to each individual patient on the basis of the anatomic location, pathogenesis, and mechanism of the vertebral artery compression. Five patients underwent removal of osteophytes at the level of the subaxial cervical spine, one patient had a discectomy, two patients had a decompression only at the level of C1–C2, and two patients had a decompression and fusion at the C1–C2 level. CONCLUSION: The transcranial Doppler is extremely useful to document the altered hemodynamics preoperatively and verify the return of normal posterior circulation velocities after the surgical decompression in patients with rotational vertebrobasilar ischemia. Surgical treatment is very effective, and excellent long-term results can be expected in the vast majority of patients after decompression of the vertebral artery.

Study on the correlation of vertebral artery dominance, basilar artery curvature and posterior circulation infarction

2015 ◽  
Vol 116 (3) ◽  
pp. 287-293 ◽  
Author(s):  
Wei Zhu ◽  
Ya-fang Wang ◽  
Xiao-feng Dong ◽  
Hong-xuan Feng ◽  
He-qing Zhao ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Basilar Artery ◽  
Posterior Circulation

Intracranial Vertebral Artery Disease in the New England Medical Center Posterior Circulation Registry

1997 ◽  
Vol 37 (3) ◽  
pp. 146-156 ◽  
Author(s):  
M. Müller-Küppers ◽  
K.J. Graf ◽  
M.S. Pessin ◽  
L.D. DeWitt ◽  
L.R. Caplan
Keyword(s):  
New England ◽  
Vertebral Artery ◽  
Medical Center ◽  
Posterior Circulation ◽  
Artery Disease ◽  
England Medical

scholarly journals Digital intravascular pressure wave recording during endovascular treatment reveals abnormal shunting flow in vertebral venous fistula of the vertebral artery: illustrative case

2021 ◽  
Vol 2 (2) ◽  
Author(s):  
Yoshiteru Shimoda ◽  
Shinya Sonobe ◽  
Kuniyasu Niizuma ◽  
Toshiki Endo ◽  
Hidenori Endo ◽  
...  
Keyword(s):  
Blood Flow ◽  
Endovascular Treatment ◽  
Vertebral Artery ◽  
Resistance Index ◽  
Illustrative Case ◽  
Limb Weakness ◽  
Dicrotic Notch ◽  
The Central Nervous System ◽  
Venous Fistula ◽  
The Right

BACKGROUND An arteriovenous fistula is an abnormal arteriovenous shunt between an artery and a vein, which often leads to venous congestion in the central nervous system. The blood flow near the fistula is different from normal artery flow. A novel method to detect the abnormal shunting flow or pressure near the fistula is needed. OBSERVATIONS A 76-year-old woman presented to the authors’ institute with progressive right upper limb weakness. Right vertebral angiography showed a fistula between the right extracranial vertebral artery (VA) and the right vertebral venous plexus at the C7 level. The patient underwent endovascular treatment for shunt flow reduction. Before the procedure, blood pressures were measured at the proximal VA, distal VA near the fistula, and just at the fistula and drainer using a microcatheter. The blood pressure waveforms were characteristically different in terms of resistance index, half-decay time, and appearance of dicrotic notch. The fistula was embolized with coils and N-butyl cyanoacrylate solution. LESSONS During endovascular treatment, the authors were able to digitally record the vascular pressure waveform from the tip of the microcatheter and succeeded in calculating several parameters that characterize the shunting flow. Furthermore, these parameters could help recognize the abnormal blood flow, allowing a safer endovascular surgery.

Relationship between Vertebral Artery Hypoplasia and Posterior Circulation Ischemia

2016 ◽  
Vol 25 (2) ◽  
pp. 266-269 ◽  
Author(s):  
Hidetaka Mitsumura ◽  
Shinji Miyagawa ◽  
Teppei Komatsu ◽  
Toshiaki Hirai ◽  
Yu Kono ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Posterior Circulation ◽  
Vertebral Artery Hypoplasia

Vertebral Artery Disease

2015 ◽  
Author(s):  
Gregory J. Pearl ◽  
William P. Shutze
Keyword(s):  
Vertebral Artery ◽  
Posterior Circulation ◽  
Circulation System ◽  
Common Disease ◽  
Vertebrobasilar Insufficiency ◽  
Disease Patterns ◽  
Collateral Pathways ◽  
Artery Disease ◽  
The Right ◽  
Evaluation Patterns

Vertebral artery disease (VAD) is a significant cause of severe symptoms or stroke. Approximately 25 to 30% of strokes involve the posterior circulation system; VAD will be present in 20% of these and will be the source in about 10%. The ability to properly diagnose, manage, and treat VAD is an important skill for practitioners caring for patients with extracranial cerebral occlusive disease. This review covers anatomy, presentations of VAD, evaluation, patterns of disease, treatment, and other vertebral artery (VA) syndromes. Tables outline symptoms and differential diagnoses of vertebrobasilar insufficiency, etiologies of VA compression syndromes, posterior circulation cerebrovascular accident symptoms and associated syndromes, and ultrasonography velocity and VA stenosis. Figures show the anatomy of the VA, circle of Willis, aberrant arteries, VA compression, ischemic posterior circulation, collateral pathways to the VA, common disease patterns in VAD, VA to carotid artery anastomosis, incision for the V3 bypass, VA aneurysm, VA dissection, angiography of the right VA, giant cell arteritis, and fibromuscular dysplasia. Radiologic videos are provided. This review contains 15 figures, 6 tables, 7 videos, and 71 references.

Abstract 1122‐000027: Bilateral Vertebral Artery Occlusion and Involvement of the Posterior Circulation

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Brian A Tong ◽  
Dan‐Victor Giurgiutiu
Keyword(s):  
Vertebral Artery ◽  
Collateral Circulation ◽  
Lumbar Fusion ◽  
Artery Occlusion ◽  
Posterior Circulation ◽  
Collateral Flow ◽  
Total Occlusion ◽  
Mortality And Morbidity ◽  
Vertebral Artery Occlusion ◽  
History Of

Introduction : Rationale: Bilateral vertebral artery occlusion with collateral reconstitution is a rare finding. Compared to patients with acute occlusion, symptom progression may be much slower [1]. Atherosclerotic risk factors lead to occlusion, including hypertension and hyperlipidemia, but it is unclear what leads to collateral reconstitution [2]. These patients may have collateral circulation from anterior and posterior circulation sources that are well developed [1] [2]. Sufficient collateral flow correlates with lower rates of hemorrhagic transformation following recanalization [3] [4]. However, given the risk of spontaneous hemorrhage from microvascular collaterals, the hemorrhagic risk associated with thrombolytic therapy in patients with moyamoya collaterals, due to the fragility of these vessels [5], must be balanced with the benefit of therapy in the presence of severe neurologic deficits along with the mortality and morbidity that may stem from the occlusion. Patient concerns: 67 year old Caucasian male with past medical history of coronary artery disease, abdominal aortic aneurysm, hypertension, history of tobacco use and type 2 diabetes mellitus presents with acute right‐sided weakness. Methods : Diagnoses: On admission, CTA Head and Neck suggested chronic total occlusion of bilateral V4 segments from their origin to the midportion with tandem bilateral high‐grade stenoses throughout the imaged distal V2 and V3 segments bilaterally. MRI could not be obtained because of old lumbar fusion spinal hardware. Cerebral angiography showed microvascular reconstitution, analogous to moyamoya, with slow mid basilar flow, which could be either due to occlusion or competitive flow from top of the basilar collaterals. Interventions: Patient received intra‐arterial integrilin and tPA thrombolysis with TICI 1 reperfusion. Results : Outcomes: Patient presented with NIHSS 18 notable for right sided weakness (2/5 strength in his right upper extremity and 1/5 strength in RLE), bilateral hemianopia, severe dysarthria and right gaze preference. Patient had significant improvement in his exam the next day following thrombolysis. Notably, patient had 5/5 strength in his right upper and right lower extremities compared to his strength on presentation. Repeat head CT on the following day after thrombolysis showed left pontine infarct. Repeat NIHSS was 3 at 24 hours for partial hemianopia, minor nasolabial flattening and mild dysarthria. Conclusions : Conclusion: Bilateral intracranial vertebral artery stenosis and occlusion commonly occurs distal to PICA and near the vertebrobasilar junction [2]. Proximal (specifically areas supplied by PICA) and distal territories within the posterior circulation are often infarcted [2], which can yield a unique exam upon presentation that can help accurately guide diagnosis and treatment when appropriately recognized. The involvement of collateral circulation can play a crucial role in patients undergoing endovascular revascularization therapy [6]. In the setting of bilateral vertebral occlusion with microvascular reconstitution, patients can still undergo catheter based thrombolysis, but not thrombectomy.

scholarly journals Left Vertebral Artery to Common Carotid Artery Transposition in a Patient With Bilateral Vertebral Insufficiency: 3-Dimensional Operative Video

2020 ◽  
Vol 19 (3) ◽  
pp. E301-E302
Author(s):  
Sirin Gandhi ◽  
Claudio Cavallo ◽  
Justin R Mascitelli ◽  
Michael J Nanaszko ◽  
Xiaochun Zhao ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Vertebral Artery ◽  
Common Carotid Artery ◽  
Suture Technique ◽  
Posterior Circulation ◽  
Left Vertebral Artery ◽  
Vertebrobasilar Insufficiency ◽  
Subclavian Steal ◽  
Bypass Patency ◽  
Patient Consent

Abstract Extracranial vertebral artery (VA) atherosclerosis is responsible for 14% to 32% of posterior circulation infarctions.1 In the posterior circulation, narrowing of the VA > 30% is significantly associated with strokes. Subclavian artery (SCA) atherosclerosis can produce subclavian steal. Retrograde VA flow around an occluded SCA decreases blood flow to the posterior circulation and causes vertebrobasilar insufficiency (VBI). Flow augmentation to the posterior circulation can be achieved by VA endarterectomy, arterial stenting, VA-common carotid artery (CCA) transposition, or bypass using an interposition graft.2,3 This video illustrates microsurgical revascularization of the proximal VA with VA-CCA transposition. A 58-yr-old man with a prior stroke and chronic right VA occlusion presented with dysarthria and gait instability. Angiographic evaluation confirmed complete midcervical right VA occlusion and left SCA occlusion proximal to VA origin, with subclavian steal. After obtaining patient consent and a failed attempt at endovascular recanalization of the left SCA, a left VA-CCA end-to-side transposition was performed. Neck dissection exposed the left CCA. The thyrocervical trunk served as a landmark to identify the SCA, which was traced proximally to the VA origin. After proximal occlusion, the VA was transected and “fish-mouthed” for end-to-side anastomosis to CCA. An intraluminal, continuous suture technique was used to sew the back walls of this anastomosis. Postoperative computed tomography angiography confirmed bypass patency. Collateral circulation through the thyrocervical and costocervical trunks likely supplied the left arm, and no cerebral, or limb, ischemic symptoms were noted on follow-up. VA-CCA transposition is an uncommon technique for safe and effective revascularization of symptomatic, medically refractory VBI caused by VA occlusion or, as in this case, SCA occlusion with secondary subclavian steal. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.

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