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Valenzuela-Fuenzalida JJ, Rojas-Navia CP, Quirós-Clavero AP, Sanchis-Gimeno J, Rodriguez-Luengo M, Nova-Baeza P, Orellana-Donoso M, Becerra Farfán Á, Bruna-Mejias A, Sepúlveda-Loyola W, Iwanaga J. Anatomy of vertebral artery hypoplasia and its relationship with clinical implications: a systematic review and meta-analysis of prevalence. Surg Radiol Anat 2024; 46:963-975. [PMID: 38762843 DOI: 10.1007/s00276-024-03377-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 04/26/2024] [Indexed: 05/20/2024]
Abstract
PURPOSE The vertebral artery (VA) is a vital branch of the subclavian artery, coursing through the transverse foramina of the cervical vertebrae, and playing a crucial role in irrigating the posterior region of the arterial cerebral circle, also known as the Polygon of Willis. Among the various possible alterations that can affect the VA, vertebral artery hypoplasia (HAV) emerges as a significant variant. This study aims to discern the anatomical features of HAV and its correlation with the clinical conditions of the posterior cerebral circulation. METHODS The databases Medline, Scopus, Web of Science, Google Scholar, CINAHL, and LILACS were searched until January 2024. Two authors independently performed the search, study selection, and data extraction. Methodological quality was evaluated with an assurance tool for anatomical studies (AQUA). Pooled prevalence was estimated using a random effects model. RESULTS A total of 24 studies met the established selection criteria, with a total of 8847 subjects. In this study, 6 articles were included for the meta-analysis with a total of subjects. The average prevalence of VAH reported in each study was 11% (95% CI 10-12%); the studies had a heterogeneity of 41% based on the funnel plot and a low risk of bias. CONCLUSION The prevalence of VAH is low, but in the presence of this condition, the changes are mainly in diameter rather than morphological. If it is present, some clinical safeguards must be taken to avoid complications such as stroke.
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Affiliation(s)
- Juan José Valenzuela-Fuenzalida
- Department of Morphology and Function, Faculty of Health and Social Sciences, Universidad de Las Américas, 8370040, Santiago, Chile.
- Departamento de Morfología, Facultad de Medicina, Universidad Andrés Bello, 8370146, Santiago, Chile.
| | | | - Amanda Paz Quirós-Clavero
- Departamento de Morfología, Facultad de Medicina, Universidad Andrés Bello, 8370146, Santiago, Chile
| | - Juan Sanchis-Gimeno
- GIAVAL Research Group, Department of Anatomy and Human Embryology, Faculty of Medicine, University of Valencia, 46001, Valencia, Spain
| | - Macarena Rodriguez-Luengo
- Departamento de Morfología, Facultad de Medicina, Universidad Andrés Bello, 8370146, Santiago, Chile
| | - Pablo Nova-Baeza
- Departamento de Morfología, Facultad de Medicina, Universidad Andrés Bello, 8370146, Santiago, Chile
| | - Mathias Orellana-Donoso
- Escuela de Medicina, Universidad Finis Terrae, 7501015, Santiago, Chile
- Departamento de Morfología, Facultad de Medicina, Universidad Andrés Bello, 8370146, Santiago, Chile
| | - Álvaro Becerra Farfán
- Departamento de Ciencias Química y Biológicas, Facultad de Ciencias de La Salud, Universidad Bernardo O'Higgins, 8370993, Santiago, Chile
| | - Alejandro Bruna-Mejias
- Departamento de Morfología, Facultad de Medicina, Universidad Andrés Bello, 8370146, Santiago, Chile
| | - Walter Sepúlveda-Loyola
- Faculty of Health and Social Sciences, Universidad de Las Américas, 8370040, Santiago, Chile
| | - Joe Iwanaga
- Department of Oral and Maxillofacial Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA
- Department of Neurology, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA
- Department of Structural & Cellular Biology, Tulane University School of Medicine, New Orleans, LA, USA
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Simultaneous Association of Variations in the Origin and Diameter of the Left Vertebral Artery in a Patient with a C1 Lateral Mass Tumor. Case Rep Surg 2022; 2022:1025019. [PMID: 35527807 PMCID: PMC9072035 DOI: 10.1155/2022/1025019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 04/11/2022] [Indexed: 01/10/2023] Open
Abstract
The anomalous origin of a hypoplastic Left Vertebral Artery (LVA) from the aortic arch is a rare anatomic variant. This study discusses the case of a patient with a C1 lateral mass tumor that surrounded a dominant Right Vertebral Artery (RVA) according to preoperative computed tomography angiography, with a hypoplastic LVA originating from the aortic arch. Surgery was performed, and the patient recovered uneventfully. To date, no study has reported the simultaneous association of two variations (origin and diameter) in the LVA. A deep understanding of abnormalities in the diameter and origin of LVA is a must for neurosurgeons as well as for thoracic and vascular surgeons to conduct surgical procedures.
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Radiological anatomy of the intracranial vertebral artery in a select South African cohort of patients. Sci Rep 2021; 11:12138. [PMID: 34108602 PMCID: PMC8190432 DOI: 10.1038/s41598-021-91744-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 05/20/2021] [Indexed: 01/02/2023] Open
Abstract
The intracranial segment of the vertebral artery (VA) is the unique part of the artery where the two VAs join to form a single vascular channel, viz. the basilar artery. In addition to this typical description, anatomical variations have been described; the presence of anatomical variation has been associated with some pathological processes, neurological complications, and the risk of vascular diseases in the posterior circulatory territory. We evaluated the typical anatomical features and variations of the VA4 component of the VA in a South African population to provide useful data on the prevalence of variation and morphometry of the distal VA. The study is an observational, retrospective chart review of 554 consecutive South African patients (Black, Indian, and Caucasian) who had been examined with multidetector computed tomography angiography (MDCTA) from January 2009 to September 2019. We observed various anatomical variations in the VA4 segment of the VA. We report the incidence of VA hypoplasia, hypoplastic terminal VA, and atresia. Fenestration and duplicate posterior inferior cerebellar artery (PICA) origin were also observed. The left intracranial VA was significantly larger than the right. Our study shows that anatomical variation of the intracranial VA is common in the population studied, with a total prevalence of 36.5%. Understanding the patterns of anatomical variations of the VAs will contribute significantly to the interpretation of ischemic areas and diagnosis of various diseases in the posterior circulatory territory.
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Bow hunter's syndrome in a patient with vertebral artery atresia, an arcuate foramen, and unilateral deafness: a case report. Radiol Case Rep 2017; 12:597-601. [PMID: 28828133 PMCID: PMC5551958 DOI: 10.1016/j.radcr.2017.04.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 04/04/2017] [Indexed: 02/06/2023] Open
Abstract
Bow hunter's syndrome (BHS) is a rare cause of vertebrobasilar insufficiency that occurs when the vertebral artery (VA) is occluded on rotation of the head and neck. This dynamic occlusion of the VA can occur anywhere along its course after it arises from the subclavian artery. Although most cases are associated with compression by osteophytes, cervical spondylosis, or lateral disc herniation, BHS has a highly variable clinical course that depends on the patient's specific anatomy. Therefore, it may be important for clinicians to be aware of anatomical variants that predispose individuals to BHS. Here, we report on a patient with BHS who was found to have two uncommon anatomical anomalies: an atretic right VA and a left-sided arcuate foramen.
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