1
|
Sarmiento JM, Cohen JD, Babadjouni RM, Quintero-Consuegra MD, Gonzalez NR, Perry TG. Evaluation of tortuous vertebral arteries before cervical spine surgery: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2021; 1:CASE2198. [PMID: 35855017 PMCID: PMC9245845 DOI: 10.3171/case2198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 03/03/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND
Cervical spine surgery sometimes necessitates complex ventral/dorsal approaches or osteotomies that place the vertebral artery (VA) at risk of inadvertent injury. Tortuosity of the VA poses increased risk of vessel injury during anterior decompression or placement of posterior instrumentation.
OBSERVATIONS
In this report, the authors describe a patient with degenerative cervical spondylotic myelopathy and focal kyphotic deformity requiring corrective surgery via a combined ventral/dorsal approach. Computed tomography (CT) and CT angiography (CTA) of the spine identified a left medially enlarged C4 transverse foramen and tortuous VA V2 segment forming a potentially dangerous medial loop into the vertebral body, respectively. The patient’s presentation and management are described.
LESSONS
The course of the VA is variable, and a tortuous VA with significant medial or lateral displacement may be dangerous during ventral and dorsal approaches to the cervical spine. CTA of the cervical spine is warranted in cases in which atlantoaxial fixation is needed or suspicious transverse foramen morphology is identified to understand the course of the VA and identify anatomical variations that would put the VA at risk during cervical spine surgery.
Collapse
|
2
|
Classifying vertebral artery anatomy abnormality in children with skeletal dysplasia. Spine Deform 2021; 9:833-839. [PMID: 33403655 DOI: 10.1007/s43390-020-00264-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 11/23/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE Skeletal dysplasia (SKD) have predictably abnormal occipitocervical skeletal anatomy, but a similar understanding of their vertebral artery anatomy is not known. Knowledge and classification of vertebral artery anatomy in SKD patients is important for safe surgical planning. We aimed to determine if predictably abnormal vertebral artery anatomy exists in pediatric SKD. METHODS We performed a retrospective review of CTAs of the neck for pediatric patients at a single institution from 2006 to 2018. CTAs in SKD and controls were reviewed independently in blinded fashion by two radiologists who classified dominance, vessel curvature at C2, direction at C3, and presence of fenestration and intersegmental artery. RESULTS 14 skeletal dysplasia patients were compared to 32 controls. The path of the vertebral artery at C2 foramen was no different between the cohorts or by side, right (p = 0.43) or left (p = 0.13), nor for medial or lateral exiting direction from C3 foramen on right (p = 0.82) or left (p = 0.60). Dominance was most commonly neutral in both groups (71% in SKD and 63% in controls). There were no fenestrated nor first intersegmental arteries in our cohort. CONCLUSION No systematic differences were detected between SKD and control patients with respect to vertebral artery anatomy. Nonetheless, surgically relevant variability was observed in both groups. Paying particular attention to the direction of exit at C3 and curvature at C2 with respect to the foramen and vessel dominance are important and easily classifiable abnormalities that both surgeons and radiologists can use to communicate and employ in pre-operative planning. LEVEL OF EVIDENCE III.
Collapse
|
3
|
Guo Q, Zhou X, Guo X, Han Z, Chen F, Zhu J, Lu X, Ni B. C2 partial transpedicular screw technique for atlantoaxial dislocation with high-riding vertebral artery: A technique note with case series. Clin Neurol Neurosurg 2020; 200:106403. [PMID: 33338827 DOI: 10.1016/j.clineuro.2020.106403] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 11/23/2020] [Accepted: 11/25/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Although the C2 pedicle screw (C2PS) is currently the most biomechanically robust option for C2 fixation, the high-riding vertebral artery (HRVA) precludes safe C2PS placement. However, unintentional partial C2 pedicle perforation and vertebral foramen violation due to C2PS placement without neurovascular complications occurred frequently in clinic. Therefore, we have attempted to apply C2 partial transpedicular screw (C2PTS) in patients with HRVA with satisfactory preliminary outcomes. The aim of the present study is to introduce the C2PTS technique and report the preliminary radiological and clinical outcomes of application of C2PTS. PATIENTS AND METHODS The data of 15 patients with atlantoaxial dislocation underwent atlantoaxial arthrodesis with posterior screw-rod construct were retrospectively reviewed. All patients had unilateral or bilateral HRVA that precluded safe C2PS placement and C2PTS was used as an alternative. In this technique, a Penfield dissector was used to properly mobilize the HRVA inferiorly to preclude vertebral artery injury and pave the way for C2PTS placement. The C2PTS travelled under the superior border of the isthmus and toward the ipsilateral atlantoaxial articulation. The implant position and atlantoaxial reduction were evaluated using computed tomography (CT) scans and vertebral artery (VA) was assessed using CT angiography postoperatively. RESULTS Satisfactory C2PTS placement and atlantoaxial reduction were achieved in all patients. Postoperatively, no vertebral artery injury and implant failure were observed, and bone fusion was achieved in all the patients. Additionally, there were no VA occlusion or stenosis due to screws demonstrated on VA CT angiography. CONCLUSION C2PTS can achieve three-column fixation of axis and is an efficient alternative to C2PS which is prohibited due to HRVA; also, gently mobilizing the HRVA inferiorly is mandatory to prevent vertebral artery injury during C2PTS placement.
Collapse
Affiliation(s)
- Qunfeng Guo
- From the Department of Orthopedics, Changzheng Hospital, The Second Military Medical University, Shanghai, People's Republic of China
| | - Xin Zhou
- From the Department of Orthopedics, Changzheng Hospital, The Second Military Medical University, Shanghai, People's Republic of China
| | - Xiang Guo
- From the Department of Orthopedics, Changzheng Hospital, The Second Military Medical University, Shanghai, People's Republic of China
| | - Zhao Han
- From the Department of Orthopedics, Changzheng Hospital, The Second Military Medical University, Shanghai, People's Republic of China
| | - Fei Chen
- From the Department of Orthopedics, Changzheng Hospital, The Second Military Medical University, Shanghai, People's Republic of China
| | - Jingyu Zhu
- From the Department of Orthopedics, Changzheng Hospital, The Second Military Medical University, Shanghai, People's Republic of China
| | - Xuhua Lu
- From the Department of Orthopedics, Changzheng Hospital, The Second Military Medical University, Shanghai, People's Republic of China
| | - Bin Ni
- From the Department of Orthopedics, Changzheng Hospital, The Second Military Medical University, Shanghai, People's Republic of China.
| |
Collapse
|
4
|
Li T, Yin YH, Qiao GY, Wang HW, Yu XG. Three-Dimensional Evaluation and Classification of the Anatomy Variations of Vertebral Artery at the Craniovertebral Junction in 120 Patients of Basilar Invagination and Atlas Occipitalization. Oper Neurosurg (Hagerstown) 2020; 17:594-602. [PMID: 31127851 DOI: 10.1093/ons/opz076] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 12/25/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Patients with basilar invagination and atlas occipitalization usually present abnormal anatomy of the vertebral arteries (VAs) at the craniovertebral junction (CVJ). OBJECTIVE To describe and further classify different types of VA variations at the CVJ with 3D visualization technology. METHODS One hundred twenty patients with basilar invagination and atlas occipitalization who had undergone 3-dimensional computed tomographic angiography (3D-CTA) were retrospectively studied. Imaging data were processed via the separating, fusing, opacifying, and false-coloring-volume rendering technique. Abnormal anatomy of the VA at the CVJ was categorized and related anatomic parameters were measured. RESULTS Seven different types were classified. Type I, VAs enter the cranium after leaving VA groove on the posterior arch of atlas (26.7% of 240 sides); Type II, VAs enter an extraosseous canal created in the assimilated atlas lateral mass-occipital condyle complex before reaching the cranium (53.3%); Type III, VA courses above the axis facet or curves below the atlas lateral mass then enter the cranium (11.7%); Type IV, VAs enter the spinal canal under the axis lamina (1.3%); Type V, high-riding VA (31.3%); Type VI, fenestrated VA (2.9%); Type VII, absent VA (4.2%). Distance from the canal of Type II VA to the posterior facet surface of atlas lateral mass (5.51 ± 2.17 mm) means a 3.5-mm screw can be safely inserted usually. Shorter distance from the midline (13.50 ± 4.35) illustrates potential Type III VA injury during exposure. Decreased height and width of axis isthmus in Type V indicate increased VA injury risks. CONCLUSION Seven types of VA variations were described, together with valuable information helpful to minimize VA injury risk intraoperatively.
Collapse
Affiliation(s)
- Teng Li
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China
| | - Yi-Heng Yin
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China
| | - Guang-Yu Qiao
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China
| | - Hua-Wei Wang
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China
| | - Xin-Guang Yu
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China
| |
Collapse
|
5
|
Ortega-Balderas JA, Sada-Treviño MA, Barrera-Flores FJ, Zárate-Garza PP, Lugo-Guillén RA, Gómez-Sánchez A, Pinales-Razo R, Elizondo-Riojas G, Guzmán-López S, Elizondo-Omaña RE. Avoiding iatrogenic injuries to the vertebral artery: A morphometric study of the vertebral artery-free dissection area. Clin Neurol Neurosurg 2020; 196:106001. [PMID: 32534385 DOI: 10.1016/j.clineuro.2020.106001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/03/2020] [Accepted: 06/06/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To determine the area of a safety window that excludes the vertebral artery for the safe access of the occipital condyle screws during occipitocervical fixation. METHODS This study included 138 cervical computed tomography angiograms. Six measurements per side were made in each imaging study. These measurements are from the vertebral artery to (A) the mastoid process, (B) the mastoid incisura, (C) the posterior condylar fossa, (D) the occipital condyle in its midline, and (E) the medial border of the condyle. We also measured from the tip of the mastoid process to the lower border of the occipital condyle on its lateral side (F). RESULTS A total of 276 areas from 138 individuals were included, of which 51.4 % were men. The mean age was 54.2 ± 18.63 years. The mean variable measurements (mm) for all the population were 21 ± 4, 16 ± 3, 6 ± 2, 3 ± 2, 2 ± 1 and 35 ± 4 for variables A-F, respectively. We found significant differences between sex when we compared measurements A (p = 0.003), C (p = 0.001), D (p = 0.000) and F (p = 0.000). The incidence rate of dominance for the vertebral artery was 18.8 % and 30.4 % for right and left respectively. CONCLUSION Women had significantly smaller measures than men. This could indicate a higher risk of iatrogenic injury secondary to a smaller vertebral artery-free area. Results may guide surgeons in the pre-surgical planning aiming to reduce the risk of iatrogenic injuries to the vertebral artery.
Collapse
Affiliation(s)
- Jessica A Ortega-Balderas
- Human Anatomy Department, Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey 64460, Nuevo León, Mexico.
| | - Miguel A Sada-Treviño
- Radiology and Imaging Department, Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey 64460, Nuevo León, Mexico.
| | - Francisco J Barrera-Flores
- Human Anatomy Department, Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey 64460, Nuevo León, Mexico.
| | - Pablo P Zárate-Garza
- Human Anatomy Department, Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey 64460, Nuevo León, Mexico.
| | - Roberto A Lugo-Guillén
- Human Anatomy Department, Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey 64460, Nuevo León, Mexico.
| | - Arnulfo Gómez-Sánchez
- Human Anatomy Department, Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey 64460, Nuevo León, Mexico.
| | - Ricardo Pinales-Razo
- Radiology and Imaging Department, Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey 64460, Nuevo León, Mexico.
| | - Guillermo Elizondo-Riojas
- Radiology and Imaging Department, Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey 64460, Nuevo León, Mexico.
| | - Santos Guzmán-López
- Human Anatomy Department, Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey 64460, Nuevo León, Mexico.
| | - Rodrigo E Elizondo-Omaña
- Human Anatomy Department, Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey 64460, Nuevo León, Mexico.
| |
Collapse
|
6
|
Zhang H, Chai W, Wang S, Wang Y, Li H. Persistent first intersegmental artery (PFIA) visualized by three-dimensional computed tomography angiography in Chinese population. Int J Surg 2018; 52:233-236. [DOI: 10.1016/j.ijsu.2018.02.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Revised: 01/29/2018] [Accepted: 02/15/2018] [Indexed: 10/18/2022]
|
7
|
Prevalence of High-Riding Vertebral Artery and Morphometry of C2 Pedicles Using a Novel Computed Tomography Reconstruction Technique. Asian Spine J 2016; 10:1141-1148. [PMID: 27994792 PMCID: PMC5165006 DOI: 10.4184/asj.2016.10.6.1141] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 04/23/2016] [Accepted: 05/08/2016] [Indexed: 11/22/2022] Open
Abstract
Study Design Cross-sectional, matched-pair comparative study. Purpose To determine whether a thin-sliced pedicular-oriented computed tomography (TPCT) scan reconstructed from an existing conventional computed tomography (CCT) scan is more accurate for identifying vertebral artery groove (VAG) anomalies than CCT. Overview of Literature Posterior atlantoaxial transarticular screw fixation and C2 pedicle screws can cause vertebral artery (VA) injury. Two anatomic variations of VAG anomalies are associated with VA injury: a high-riding VA (HRVA) and a narrow pedicle of the C2 vertebra. CCT scan is a reliable method used to evaluate VAG anomalies; however, its accuracy level remains debatable. Literature comparing the prevalence of C2 VAG anomalies between CCT and TPCT is limited. Methods A total of 200 computed tomography scans of the upper cervical spine obtained between January 2008 and December 2011 were evaluated for C2 VAG anomalies (HRVA and narrow pedicular width) using CCT and TPCT. The prevalence of C2 VAG anomalies was compared using these two different measurement methods via a McNemar's test. Results Of the 200 patients studied, 23 HRVA (6.01%; 95% confidence interval [CI], 3.61%–8.39%) were detected with CCT, whereas 66 HRVA (16.54%; 95% CI, 12.85%–20.23%) were detected with TPCT (p<0.001). Sixty-two narrow pedicles (15.58%; 95% CI, 11.99%–19.15%) were detected with CCT, whereas 90 narrow pedicles (22.83%; 95% CI, 18.58%–26.87%) were detected with TPCT (p<0.001). Conclusions VAG anomalies are commonly observed. A preoperative evaluation using TPCT reconstructed from an existing CCT revealed a significantly higher prevalence of C2 VAG anomalies than did CCT and showed comparable prevalence to previously published studies using more sophisticated and higher risk techniques. Therefore, we propose TPCT as an alternative preoperative evaluation for C2 screw placement and trajectory planning.
Collapse
|
8
|
Arterial variations around the atlas: a comprehensive review for avoiding neurosurgical complications. Childs Nerv Syst 2016; 32:1093-100. [PMID: 27003576 DOI: 10.1007/s00381-016-3066-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 03/13/2016] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Neurosurgical approaches often involve the atlas. Therefore, the arterial relationships and anatomical variations are of paramount importance to the neurosurgeon. METHODS Using standard search engines, a literature review of arterial variants near the first cervical vertebra was performed. CONCLUSIONS Arterial variations around the atlas are surgically significant. Awareness of their existence and course may provide better pre-operative planning and surgical intervention, potentially leading to better clinical outcomes. Three-dimensional computed tomography angiography (3D CTA) is an important tool for identifying and diagnosing such abnormalities and should be used when such vascular anomalies are suspected.
Collapse
|
9
|
Pruthi N, Dawn R, Ravindranath Y, Maiti TK, Ravindranath R, Philip M. Computed tomography-based classification of axis vertebra: choice of screw placement. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2014; 23:1084-91. [PMID: 24563273 DOI: 10.1007/s00586-014-3240-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2013] [Revised: 02/05/2014] [Accepted: 02/06/2014] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of the study was to: (1) introduce a new CT-based parameter: free facet area and provide its normative data; (2) standardize the method of measuring isthmus width and height of the axis vertebra; (3) propose a new grading system to predict the difficulty in inserting transarticular and C2 pedicle screws. METHODS Spiral CT scans of 47 adult dry axis vertebrae were studied. The methods of measuring isthmus width, isthmus height and free facet area are described. RESULTS The mean isthmus width was 5.04 mm on the right side and 5.42 mm on the left side. The mean isthmus height was 5.21 mm on the right side and 5.45 mm on the left side. Mean free facet area was 61.23 % on the right side and 70.18 % on the left side. A novel grading system is proposed on the basis of these three parameters. As per this grading system, 40.4 % of the sides were found to be difficult for transarticular and 24.5 % sides for C2 pedicle screw insertion (total score 2, 3, 4). A Management protocol is suggested on the basis of the grading system. CONCLUSION Inserting a transarticular screw was more frequently difficult as compared to pedicle screw. A new CT-based parameter (free facet area) and an efficient grading have been proposed to help surgeons choose the appropriate screw options, appreciate the complex anatomy of this region and compare data across various studies.
Collapse
Affiliation(s)
- Nupur Pruthi
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bangalore, 560 029, Karnataka, India,
| | | | | | | | | | | |
Collapse
|
10
|
Three-Dimensional CT Imaging with Volume Rending of Separating Fusing, Opacifying and False-Coloring Technique. ACTA ACUST UNITED AC 2013. [DOI: 10.4028/www.scientific.net/amm.423-426.2606] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
This paper proposes a three-dimensional CT imaging (3DCT) method to show the anatomical structures. With the CT volume scanning data, 3DCT imaging with volume rendering of separating, fusing, opacifying and false-coloring (SFOF-VR) techniques was done on the workstation. SFOF-VR, with separately and jointly showing the complicated anatomy and their spatial relations, is valuable in finding the variations of bone, artery and vein, and diagnosing their diseases. When comparing with routine volume rendering (R-VR), SFOF-VR provides more clear and direct anatomical basis for imaging diagnosis and surgical operation.
Collapse
|
11
|
Abstract
STUDY DESIGN.: Observational study with 3-dimensional computed tomography angiography analysis. OBJECTIVE.: To examine the course of the vertebral artery (VA) at the craniovertebral junction (CVJ) in individuals with occipitalization of the atlas. SUMMARY OF BACKGROUND DATA.: The anatomy of the VA at the CVJ should be completely understood to decrease the risk of iatrogenic injury. Although quantitative anatomic studies have focused on the normal VA, the anomalous VA with occipitalization of the atlas has not been fully explored. METHODS.: A consecutive series of 36 cases with occipitalization of the atlas underwent 3-dimensional computed tomography angiography. Seventy-two vertebral arteries were analyzed. In this setting, the safety of placing lateral mass screws (LMS) was studied. RESULTS.: Four different pathways of the VA at the CVJ with occipitalization of the atlas were found. Type I, wherein the VA enters the spinal canal below the C1 posterior arch, and the course of the VA is below the occipitalized C1 lateral mass (8.3% of 72 vertebral arteries); Type II, the VA enters the spinal canal below the C1 posterior arch, and the course of the VA is on the posterior surface of the occipitalized C1 lateral mass, or makes a curve on it (25%); Type III, wherein the VA ascends externally laterally after leaving the axis transverse foramen, enters an osseous foramen created between the atlas and occipital bone, then into the cranium (61.1%); and Type IV, in which the VA is absent (5.6%). CONCLUSION.: Four types of VA with occipitalization of the atlas are confirmed. Type-I and type-IV VA have relatively low risks for C1 LMS perforation. Type-II and type-III anomalies will probably increase the risk of VA injury during C1 LMS placement. Definite caution should also be taken during the procedure on the contralateral side of a type-IV VA.
Collapse
|
12
|
Three-dimensional CT study on the anatomy of vertebral artery at atlantoaxial and intracranial segment. Surg Radiol Anat 2009; 32:39-44. [PMID: 19707709 DOI: 10.1007/s00276-009-0552-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2008] [Accepted: 08/13/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND The atlantoaxial and intracranial segments of vertebral artery (V(3-4)) are winding around their peripheral structures. Their panorama is not easy to be observed in surgery. CT angiography (CTA) shows some advantages in this aspect. So, the aim of this study is to reveal the three-dimensional (3D) anatomy related to V(3-4) and prepare ground for clinical diagnosis and treatment. METHODS Ninety-eight cases without the pathologies of V(3-4) were selected from the head-neck CTA examination. All the 3D images were formed with multiplanar reconstruction, volume rendering and volume rendering together with separating, fusing, opacifying and false-coloring. On the 3D images, the courses and branch of V(3-4) were observed and measured, as well as their peripheral venous vascular plexus (VVP). RESULTS V(3-4) with typical five curves was found in 85 cases and with variations in 13. The left V(3-4) is larger than right (P < 0.05). The branch shown on the 3D image is the posterior inferior cerebellar artery at V(4), at most two on either side. VVP are at the back of the atlantoaxial joints and around the V(3), each on either side. There is no significant difference in size and shape between left and right (P > 0.05). CONCLUSIONS The anatomy and variations of V(3-4) can be clearly and directly shown by 3DCTA. The understanding of vertebral artery and bony structures around there can provide anatomic basis for surgery and radiological diagnosis.
Collapse
|
13
|
Duan S, Lv S, Ye F, Lin Q. Imaging anatomy and variation of vertebral artery and bone structure at craniocervical junction. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2009; 18:1102-8. [PMID: 19288143 DOI: 10.1007/s00586-009-0925-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2008] [Revised: 12/23/2008] [Accepted: 02/22/2009] [Indexed: 11/28/2022]
Abstract
The objective of this article is to display the vertebral artery and bone structure at the craniocervical junction (CJVA and C(0-1-2)) with three-dimensional CT angiography (3DCTA) and identify their anatomic features and variations. Eighty-eight subjects without pathology of vertebral artery (VA) and C(0-1-2) were selected from head-neck CTA examination. 3D images were formed with volume rendering (VR) and multiplanar reconstruction (MPR). On the 3D images, CJVA and C(0-1-2) were measured, and their variations were observed. CJVA goes along C(0-1-2) with five curves, of which three curves are visibly away from C(0-1-2), one is 0.0-8.3 mm away at the second curve with 0.0-11.2 mm in width, another is 0.0-9.2 mm away at the fourth with 2.8-14.8 mm and the other is 0.0-6.2 mm away at the fifth. Statistical comparisons show that there is no significant difference in the measurements between left and right, and that the curves become smaller and farther away from C(0-1-2) with the increase of age. CJVA is not equal in size, with the biggest in the fourth curve and the smallest in the fifth. Statistical comparison shows the left CJVA is larger than the right in the fifth curve. Variations were found on CJVA in 16 cases and on C(1) in 12 cases. The anatomy and variations of CJVA and C(0-1-2) are complicated. It is of vital significance to identify their anatomic features in clinical practice.
Collapse
Affiliation(s)
- Shaoyin Duan
- Department of Radiology, Zhongshan Hospital of Xiamen University, No. 209, South Hubin Road, 361004, Xiamen, China.
| | | | | | | |
Collapse
|