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Vilanilam GK, Gopal N, Middlebrooks EH, Huang JF, Bhatt AA. Compressive lesions of the head and neck: Common and uncommon must-know entities. Neuroradiol J 2024; 37:164-177. [PMID: 37026517 PMCID: PMC10973822 DOI: 10.1177/19714009231166083] [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] [Indexed: 04/08/2023] Open
Abstract
There are many lesions that cause compression of nerves and vessels in the head and neck, and they can often be overlooked in the absence of adequate history or if not suspected by the radiologist. Many of these lesions require a high index of suspicion and optimal positioning for imaging. While a multimodality approach is critical in the evaluation of compressive lesions, an MRI utilizing high-resolution (heavily weighted) T2-weighted sequence is extremely useful as a starting point. In this review, we aim to discuss the radiological features of the common and uncommon compressive lesions of the head and neck which are broadly categorized into vascular, osseous, and miscellaneous etiologies.
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Affiliation(s)
- George K Vilanilam
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Neethu Gopal
- Division of Neuroradiology, Department of Radiology, Mayo Clinic, Jacksonville, FL, USA
| | - Erik H Middlebrooks
- Division of Neuroradiology, Department of Radiology, Mayo Clinic, Jacksonville, FL, USA
| | | | - Alok A Bhatt
- Division of Neuroradiology, Department of Radiology, Mayo Clinic, Jacksonville, FL, USA
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2
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Neural Basis of Etiopathogenesis and Treatment of Cervicogenic Orofacial Pain. Medicina (B Aires) 2022; 58:medicina58101324. [PMID: 36295485 PMCID: PMC9611820 DOI: 10.3390/medicina58101324] [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: 08/15/2022] [Revised: 09/15/2022] [Accepted: 09/19/2022] [Indexed: 11/17/2022] Open
Abstract
(1) Background and Objectives: The aim of this narrative review was to analyze the neuroanatomical and neurophysiological basis of cervicogenic pain in cervico-cranial pain syndromes, focusing particularly on cervico-orofacial syndromes as a background for the proper diagnosis and non-surgical treatment. Relevant literature on the topic from past 120 years has been surveyed. (2) Material and Methods: We surveyed all original papers, reviews, or short communications published in the English, Spanish, Czech or Slovak languages from 1900 to 2020 in major journals. (3) Results: The cervicogenic headache originates from the spinal trigeminal nucleus where axons from the C1–C3 cervical spinal nerves and three branches of the trigeminal nerve converge (trigeminocervical convergence) at the interneurons that mediate cranio-cervical nociceptive interactions. The role of the temporomandibular joint in the broad clinical picture is also important. Despite abundant available experimental and clinical data, cervicogenic orofacial pain may be challenging to diagnose and treat. Crucial non-surgical therapeutic approach is the orthopedic manual therapy focused on correction of body posture, proper alignment of cervical vertebra and restoration of normal function of temporomandibular joint and occlusion. In addition, two novel concepts for the functional synthesis of cervico-cranial interactions are the tricentric concept of mouth sensorimotor control and the concept of a cervicogenic origin of bruxism. (4) Conclusions: Understanding the basis of neuroanatomical and neurophysiological neuromuscular relations enables an effective therapeutic approach based principally on orthopedic manual and dental occlusal treatment.
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3
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Eberhard SW, Subramanian S, Jackman CT. Cranial Neuralgias in Children and Adolescents A review of the literature. Semin Pediatr Neurol 2021; 40:100926. [PMID: 34749913 DOI: 10.1016/j.spen.2021.100926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 08/13/2021] [Accepted: 08/15/2021] [Indexed: 11/16/2022]
Abstract
Cranial neuralgias are a well-established cause of headache-related morbidity in the adult population. These disorders are poorly studied in general due to their relative rarity, particularly in children and adolescents, and they are likely underdiagnosed in these populations. Recognizing these disorders and differentiating them from more common headache disorders, such as migraine, is important, as secondary disease is common. This review will cover the basic epidemiology, diagnosis, and treatment of trigeminal, occipital, glossopharyngeal and other, less common, cranial neuralgias. We have reviewed pediatric case reports of these conditions. For trigeminal neuralgia, the most common of these disorders, we have compiled the clinical features and treatment response of previous reports.
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Affiliation(s)
- Spencer W Eberhard
- Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, IN
| | - Sharmada Subramanian
- Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, IN
| | - Christopher T Jackman
- Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, IN.
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4
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Haas P, Hauser TK, Kandilaris K, Schenk S, Tatagiba M, Adib SD. Posterolateral epidural supra-C2-root approach (PESCA) for biopsy of lesions of the odontoid process in same sitting after occipitocervical fixation and decompression-perioperative management and how to avoid vertebral artery injury. Neurosurg Rev 2021; 44:2947-2956. [PMID: 33428076 PMCID: PMC8490265 DOI: 10.1007/s10143-020-01468-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 10/29/2020] [Accepted: 12/28/2020] [Indexed: 12/02/2022]
Abstract
This study aims to describe the posterolateral epidural supra-C2-root approach (PESCA), which might be a good alternative to the transoral, anterolateral, and other posterolateral approaches for biopsy of lesions of the odontoid process (OP). The preoperative planning of PESCA included computerized tomography (CT), CT-angiography, and three-dimensional reconstruction (if possible, even with three-dimensional print) to analyze the angle of the trajectory and the anatomy of the vertebral artery (VA). For PESCA, the patient is positioned under general anesthesia in prone position. In case of an osteolytic lesion with fracture of the OP, an X-ray is performed after positioning to verify anatomic alignment. In the first step, in case of instability and compression of the spinal cord, a craniocervical fusion and decompression is performed (laminectomy of the middle part of the C1 arc and removal of the lower part of the lateral C1 arc). The trajectory is immediately above the C2 root (and under the upper rest of the lateral part of C1 arc). Even if the trajectory is narrowed, it is possible to perform PESCA without relevant traction of the spinal cord. The vertical segment of V3 of the VA at the level of C2 is protected by the vertebral foramen, and the horizontal part of V3 is protected by the remnant upper lateral part of the C1 arc (in case of normal variants). PESCA might be a good choice for biopsy of selected lesions of the OP in same sitting procedure after craniocervical stabilization and decompression.
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Affiliation(s)
- Patrick Haas
- Department of Neurosurgery, University of Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany
| | - Till-Karsten Hauser
- Department of Neuroradiology, University of Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany
| | - Kosmas Kandilaris
- Department of Neuropathology, University of Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany
| | - Sebastian Schenk
- Department of Anesthesiology and Intensive Care Medicine, University of Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany
| | - Marcos Tatagiba
- Department of Neurosurgery, University of Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany
| | - Sasan Darius Adib
- Department of Neurosurgery, University of Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.
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Endo T, Sugawara T, Higashiyama N. Cervical myelopathy due to neurovascular compression syndrome caused by persistent first intersegmental artery: a case report. BMC Neurol 2020; 20:402. [PMID: 33143678 PMCID: PMC7607829 DOI: 10.1186/s12883-020-01976-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 10/23/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Persistent first intersegmental artery (PFIA) is a rare anatomical variation of vertebral arteries and is an asymptomatic finding in most cases. Here we report a rare case of cervical myelopathy caused by spinal cord compression by the PFIA. CASE PRESENTATION The patient was a 52-year-old man who complained of numbness and burning sensation around the neck and left shoulder area, partial weakness in the left deltoid muscle, right side thermal hypoalgesia, and disturbance of deep sensation since the past 1 year, and the symptoms had gradually worsened. Magnetic resonance imaging (MRI) and computed tomography (CT) showed spinal cord compression by the left PFIA at the C1/C2 level. Because conservative treatment was ineffective, microvascular decompression (MVD) of the PFIA was performed. The left PFIA was laterally transposed using polytetrafluoroethylene (PTFE) bands and anchored to the dura mater using three PTFE bands. To achieve adequate transposition, the small blood vessels bridging the spinal cord and PFIA and the dorsal root nerve had to be sacrificed. Postoperative T2-weighted MRI showed a small hyperintense region in the lateral funiculus of the spinal cord, but no new neurological deficits were identified. In the early postoperative stage, the patient's deep sensory impairment and motor dysfunction were improved. His numbness and burning sensation almost disappeared, but slight thermal hypoalgesia remained in the lower limb. CONCLUSION MVD is an effective treatment for spinal cord compression caused by the PFIA, but further studies are necessary to help address technical difficulties and avoid complications.
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Affiliation(s)
- Takuro Endo
- Department of Spinal Surgery, Akita Cerebrospinal and Cardiovascular Center, 6-10 Senshu Kubotamachi, Akita-shi, Akita-ken, 010-0874, Japan.
| | - Taku Sugawara
- Department of Spinal Surgery, Akita Cerebrospinal and Cardiovascular Center, 6-10 Senshu Kubotamachi, Akita-shi, Akita-ken, 010-0874, Japan
| | - Naoki Higashiyama
- Department of Spinal Surgery, Akita Cerebrospinal and Cardiovascular Center, 6-10 Senshu Kubotamachi, Akita-shi, Akita-ken, 010-0874, Japan
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Croci DM, Koetsier E, Maino P, Reinert M, Robert T, Scarone P. Cervical Radiculopathy Caused by a Vertebral Artery Loop: Is a Focused Fluoroscopic-Guided Cervical Epidural Steroid Injection a Possible Treatment Modality? Pain Pract 2020; 20:787-791. [PMID: 32306517 DOI: 10.1111/papr.12903] [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: 03/11/2020] [Revised: 04/08/2020] [Accepted: 04/14/2020] [Indexed: 11/30/2022]
Abstract
We describe a case of a patient suffering with cervical radiculopathy due to vertebral artery loop with nerve root compression, treated with an epidural steroid injection. A 37-year-old man presented with a 2-year history of right-sided radicular pain along the C7 dermatome. Imaging showed a right-sided loop of the vertebral artery at the V1-V2 transition with contact on the C7 nerve root. The pain was resistant to conservative treatment, and the decision was made to perform a focused fluoroscopy-guided translaminar epidural steroid injection near the C7 nerve root. The procedure was uneventful, and the symptoms resolved completely after the procedure. Targeted epidural steroid injection might be a useful and safe diagnostic and therapeutic approach in patients affected by cervical radiculopathy due to a VA loop. To our knowledge, this is the first case of a VA loop associated with cervical radiculopathy treated with this technique.
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Affiliation(s)
- Davide Marco Croci
- Department of Neurosurgery, Neurocenter of Southern Switzerland, Regional Hospital of Lugano, Lugano, Switzerland
| | - Eva Koetsier
- Pain Management Center, Neurocenter of Southern Switzerland, Regional Hospital of Lugano, Lugano, Switzerland.,Division of Anaesthesiology, Department of Acute Medicine, Regional Hospital of Lugano, Lugano, Switzerland
| | - Paolo Maino
- Pain Management Center, Neurocenter of Southern Switzerland, Regional Hospital of Lugano, Lugano, Switzerland.,Division of Anaesthesiology, Department of Acute Medicine, Regional Hospital of Lugano, Lugano, Switzerland
| | - Michael Reinert
- Department of Neurosurgery, Neurocenter of Southern Switzerland, Regional Hospital of Lugano, Lugano, Switzerland
| | - Thomas Robert
- Department of Neurosurgery, Neurocenter of Southern Switzerland, Regional Hospital of Lugano, Lugano, Switzerland
| | - Pietro Scarone
- Department of Neurosurgery, Neurocenter of Southern Switzerland, Regional Hospital of Lugano, Lugano, Switzerland
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Janjua MB, Reddy S, El Ahmadieh TY, Ban VS, Ozturk AK, Hwang SW, Samdani AF, Passias PG, Welch WC, Arlet V. Occipital neuralgia: A neurosurgical perspective. J Clin Neurosci 2019; 71:263-270. [PMID: 31606286 DOI: 10.1016/j.jocn.2019.08.102] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 08/25/2019] [Indexed: 01/03/2023]
Abstract
Occipital neuralgia typically arises in the setting of nerve compression by fibrosis, surrounding anatomic structures, or osseous pathology, such as bone spurs or hypertrophic atlanto-epistropic ligament. It generally presents as paroxysmal bouts of sharp pain in the sensory distribution of the first three occipital nerves. Due to the long course of the greater occipital nerve (GON), and its peculiar anatomy, and location in a mobile region of the neck, it is unsurprising that the GON is at high risk for compression. Little is known how to diagnose or treat this neuropathic pain syndrome. The objective of this paper is to isolate the etiology involved, and treat this condition promptly. After all nonoperative efforts are exhausted, surgical transection of the nerve is the treatment of choice in these cases. An isolated C2 neurectomy or ganglionectomy is performed for an optimal pain relief. C1-2 instrumented fusion can be considered if, extensive facet arthropathy with instability is identified. Authors review the spectrum of treatment options for this debilitating condition, and discuss the case example of a patient who required conversion to a C1-C2 instrumented fusion following C2 ganglionectomy due to an underlying extensive degenerative disease and intraoperative findings suggestive of atlantoaxial instability.
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Affiliation(s)
- M Burhan Janjua
- Department of Neurosurgery, UT Southwestern Medical Center, Dallas, TX, United States; Department of Neurosurgery, University of Pennsylvania Hospital System, Philadelphia, PA, United States; Department of Orthopedic Surgery, University of Pennsylvania Hospital System, Philadelphia, PA, United States.
| | - Sumanth Reddy
- Department of Neurosurgery, UT Southwestern Medical Center, Dallas, TX, United States
| | - Tarek Y El Ahmadieh
- Department of Neurosurgery, UT Southwestern Medical Center, Dallas, TX, United States
| | - Vin Shen Ban
- Department of Neurosurgery, UT Southwestern Medical Center, Dallas, TX, United States
| | - Ali K Ozturk
- Department of Orthopedic Surgery, University of Pennsylvania Hospital System, Philadelphia, PA, United States
| | - Steven W Hwang
- Department of Neurosurgery, Shriners Hospital for Children, Philadelphia, PA, United States
| | - Amer F Samdani
- Department of Neurosurgery, Shriners Hospital for Children, Philadelphia, PA, United States
| | - Peter G Passias
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY, United States
| | - William C Welch
- Department of Neurosurgery, University of Pennsylvania Hospital System, Philadelphia, PA, United States
| | - Vincent Arlet
- Department of Orthopedic Surgery, University of Pennsylvania Hospital System, Philadelphia, PA, United States
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8
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Venteicher AS, Quddusi A, Coumans JV. Anterolateral Approach for a Cervical Nerve Root Compression Syndrome Due to an Ectatic Vertebral Artery. Oper Neurosurg (Hagerstown) 2019; 17:E29-E32. [PMID: 30535126 DOI: 10.1093/ons/opy282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND IMPORTANCE Nerve root compression by an ectatic vertebral artery is a known but easily overlooked cause of cervical radiculopathy. Management options include nonoperative conservative therapies or surgical approaches designed to relieve the compression via anterior or posterior cervical approaches. CLINICAL PRESENTATION A 72-yr-old female presented with a 6-mo history of sharp, shooting pain in her right arm and shoulder and deltoid weakness. Imaging demonstrated a vertebral artery loop compressing the proximal right C5 nerve root. She previously underwent both nonoperative measures as well as posterior foraminotomy at this level with limited improvement in her pain. Therefore, we performed an anterolateral approach for vascular decompression of the C5 nerve root from the vertebral artery loop. Patient has been pain-free at 1 yr with full recovery of her deltoid weakness. CONCLUSION Vertebral artery loop formation is an uncommon cause of cervical radiculopathy, which can be readily treated by vascular decompression of the nerve root-vertebral artery loop complex. Although anomalous vertebral artery compression of a cervical nerve root is rare, it is increasingly being recognized as a readily treatable entity that can lead to lasting and full neurological recovery. We also include an operative video to illustrate the vascular decompression of an ectatic vertebral artery causing severe cervical radiculopathy.
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Affiliation(s)
- Andrew S Venteicher
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ayesha Quddusi
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jean V Coumans
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Ju CI, Kim JM, Kim JG, Kim SW, Lee SM. A New Sling Technique in Cervical Radiculopathy Caused by Vertebral Artery Loop Compression. World Neurosurg 2017; 104:1049.e11-1049.e15. [PMID: 28552697 DOI: 10.1016/j.wneu.2017.05.090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 05/13/2017] [Accepted: 05/16/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND A 52-year-old woman had a 20-month history of progressive radiating pain in the left arm and numbness on C7 dermatome. CASE DESCRIPTION On physical examination, left head rotation aggravated the radiculopathic pain. For an anatomic diagnosis of the vertebral artery and nerve root, magnetic resonance angiography was performed (computed tomography angiography was not possible because of her dye allergy history). Magnetic resonance angiography showed a left vertebral artery loop entering at the C6-7 intervertebral foramen. Surgical microvascular decompression was performed by an anterior cervical approach and the loop of the artery was fixed using a sling technique. Postoperative computed tomography angiography showed that the left vertebral artery was retracted anteriorly and the C7 nerve root was decompressed in the intervertebral foramen at the left C6-7 level. CONCLUSIONS The patient's radiculopathic symptoms were improved and especially the aggravated pain by left head rotation subsided dramatically.
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Affiliation(s)
- Chang Il Ju
- Department of Neurosurgery, Chosun University Hospital, Seo-gu, Gwangju, Republic of Korea.
| | - Jeong Mok Kim
- Department of Neurosurgery, Chosun University Hospital, Seo-gu, Gwangju, Republic of Korea
| | - Jong Gyu Kim
- Department of Neurosurgery, Chosun University Hospital, Seo-gu, Gwangju, Republic of Korea
| | - Seok Won Kim
- Department of Neurosurgery, Chosun University Hospital, Seo-gu, Gwangju, Republic of Korea
| | - Seung Myung Lee
- Department of Neurosurgery, Chosun University Hospital, Seo-gu, Gwangju, Republic of Korea
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The diagnosis and management of a vertebral artery loop causing cervical radiculopathy. 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 2017; 30:1-6. [PMID: 28528478 DOI: 10.1007/s00586-017-5123-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 02/26/2017] [Accepted: 04/30/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Cervical radiculopathies are rarely caused by vertebral artery loop formation, which is estimated to be present in less than 3% of patients. It is uncertain what causes the loop formation: some propose an association with spondylotic changes or trauma, whilst others suggest hypertension and atherosclerosis may be responsible. CASE REPORT 1: A 35-year-old male patient presented with signs and symptoms of cervical radiculopathy that was not improved with anterior cervical discectomy and fusion surgery performed 2 years beforehand. Vertebral artery loop was discovered at the level C5/6 on the MRI. Vertebral artery transposition surgery via a lateral approach was performed at the level of the left C5/6 for symptoms of left C6 radiculopathy. Deroofing of the transverse process was performed with post-surgical complete improvement in weakness and pain. CASE REPORT 2: A 48-year-old female patient presented with a 10-year history of left shoulder pain with occasional radiation into her middle three fingers accompanied by intermittent paraesthesia and weakness. Numerous shoulder surgeries, Botox injections and suprascapular nerve blocks had not provided any significant benefit. A vertebral artery loop was identified at the level of C3/4 and C4/5 on the left with cervical MRI. Transposition surgery of these two levels provided some post-surgical improvement in pain. CONCLUSION Vertebral artery loop formations are a rare but potential cause for cervical radiculopathy. In two cases, the loop formations were not radiographically reported on MRI, thus clinicians should be aware of this as a differential diagnosis in the management of cervical radiculopathy. The presented surgical approach may be useful in managing future cases of vertebral artery loop formation causing cervical radiculopathy resistant to conservative measures.
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11
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Double crush syndrome caused by cervical spondylosis and vertebral artery loop. 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 2017; 28:292-296. [PMID: 28508239 DOI: 10.1007/s00586-017-5064-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 03/19/2017] [Accepted: 03/21/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE The purpose of this article is to report a successful treatment experience in a rare case of simultaneous cervical nerve root compression by spondylotic cervical foraminal stenosis and a vertebral artery loop. METHODS 51-year-old man presented with a 4-year history of left-sided cervical pain radiating to the left shoulder with progressive exacerbation of weakness on left shoulder girdle muscles for 7 months. The patient had no history of trauma. The patient's CT and MRI revealed impingement of the left C6 cervical nerve root by a tortuous vertebral artery loop and also by narrowed left C5-6 cervical foramen that had undergone spondylotic changes. The patient underwent left C5-6 hemilaminectomy, facetectomy and C5-6 fusion. The procedures were uneventful, and the patient recovered with complete resolution of symptoms. RESULTS The patient continued to be asymptomatic at a 2-year follow-up examination, and the muscle mass of his left girdle returned normal. CONCLUSIONS This report illustrates the first phenomenon of a double crush syndrome caused by vertebral artery loop and cervical spondylotic changes. When patients with cervical spondylosis present with unexplainably severe pain and weakness, additional underlying pathologies should be considered when making differential diagnoses. The investigation planning should involve electromyography, computed tomography angiography, and magnetic resonance imaging.
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12
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Hemifacial Pain and Hemisensory Disturbance Referred from Occipital Neuralgia Caused by Pathological Vascular Contact of the Greater Occipital Nerve. Case Rep Neurol Med 2017; 2017:3827369. [PMID: 28331643 PMCID: PMC5346380 DOI: 10.1155/2017/3827369] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 01/12/2017] [Accepted: 02/07/2017] [Indexed: 01/03/2023] Open
Abstract
Here we report a unique case of chronic occipital neuralgia caused by pathological vascular contact of the left greater occipital nerve. After 12 months of left-sided, unremitting occipital neuralgia, a hypesthesia and facial pain developed in the left hemiface. The decompression of the left greater occipital nerve from pathological contacts with the occipital artery resulted in immediate relief for hemifacial sensory change and facial pain, as well as chronic occipital neuralgia. Although referral of pain from the stimulation of occipital and cervical structures innervated by upper cervical nerves to the frontal head of V1 trigeminal distribution has been reported, the development of hemifacial sensory change associated with referred trigeminal pain from chronic occipital neuralgia is extremely rare. Chronic continuous and strong afferent input of occipital neuralgia caused by pathological vascular contact with the greater occipital nerve seemed to be associated with sensitization and hypersensitivity of the second-order neurons in the trigeminocervical complex, a population of neurons in the C2 dorsal horn characterized by receiving convergent input from dural and cervical structures.
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13
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Wang DD, Burkhardt JK, Magill ST, Lawton MT. Anterior Transposition of Anomalous Tortuous Vertebral Artery Causing Cervical Radiculopathy: A Report of 2 Cases and Review of Literature. World Neurosurg 2017; 101:289-295. [PMID: 28192269 DOI: 10.1016/j.wneu.2017.01.129] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 01/27/2017] [Accepted: 01/30/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Cervical radiculopathy secondary to compression from vertebral artery (VA) tortuosity is a rare entity. We describe successful transposition through an anterolateral approach of tortuous VA loops causing cervical radiculopathy. METHODS Two patients with cervical radiculopathy (first case at C5-6 and second case at C3-4) secondary to anomalous VA loop compression underwent anterolateral approaches to the cervical spine for decompression and VA transposition. The anterior transverse foramina were drilled to unroof the VA loop, which was dissected free from the exiting nerve root. RESULTS In both cases, the affected cervical nerve root was successfully decompressed with both radiographic and clinical improvements in radiculopathy symptoms. We found 8 other cases of VA transposition via either an anterolateral approach or a posterolateral approach described in the literature. Our second case of anterolateral VA transposition at the C3-4 level is the first case at this level and the highest level reported in the literature. CONCLUSIONS Decompression using an anterolateral approach with direct microvascular transposition of the VA is a safe and effective treatment of this pathology and addresses the cause of radiculopathy more directly than the posterolateral approach.
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Affiliation(s)
- Doris D Wang
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Jan-Karl Burkhardt
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Stephen T Magill
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Michael T Lawton
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA.
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Abstract
Premise In this article we review some lesser known cranial neuralgias that are distinct from trigeminal neuralgia, trigeminal autonomic cephalalgias, or trigeminal neuropathies. Included are occipital neuralgia, superior laryngeal neuralgia, auriculotemporal neuralgia, glossopharyngeal and nervus intermedius neuralgia, and pain from acute herpes zoster and postherpetic neuralgia of the trigeminal and intermedius nerves. Problem Facial neuralgias are rare and many physicians do not see such cases in their lifetime, so patients with a suspected diagnosis within this group should be referred to a specialized center where multidisciplinary team diagnosis may be available. Potential solution Each facial neuralgia can be identified on the basis of clinical presentation, allowing for precision diagnosis and planning of treatment. Treatment remains conservative with oral or topical medication recommended for neuropathic pain to be tried before more invasive procedures are undertaken. However, evidence for efficacy of current treatments remains weak.
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Affiliation(s)
- Francis O'Neill
- 1 Department of Oral Surgery, Liverpool University Dental Hospital, Liverpool, UK.,2 Pain Research Institute, Clinical Sciences Centre, Fazakerley, Liverpool, UK
| | - Turo Nurmikko
- 2 Pain Research Institute, Clinical Sciences Centre, Fazakerley, Liverpool, UK.,3 Neuroscience Research, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Claudia Sommer
- 4 Department of Neurology, University of Würzburg, Germany
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15
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Finiels PJ, Batifol D. The treatment of occipital neuralgia: Review of 111 cases. Neurochirurgie 2016; 62:233-240. [DOI: 10.1016/j.neuchi.2016.04.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 03/20/2016] [Accepted: 04/06/2016] [Indexed: 12/12/2022]
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Fujiwara Y, Izumi B, Fujiwara M, Nakanishi K, Tanaka N, Adachi N, Manabe H. C2 spondylotic radiculopathy: the nerve root impingement mechanism investigated by para-sagittal CT/MRI, dynamic rotational CT, intraoperative microscopic findings, and treated by microscopic posterior foraminotomy. 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 2016; 26:1073-1081. [PMID: 27443532 DOI: 10.1007/s00586-016-4710-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Revised: 06/22/2016] [Accepted: 07/15/2016] [Indexed: 11/28/2022]
Abstract
PURPOSE C2 radiculopathy is known to cause occipito-cervical pain, but their pathology is unclear because of its rarity and unique anatomy. In this paper, we investigated the mechanism of C2 radiculopathy that underwent microscopic cervical foraminotomies (MCF). METHODS Three cases with C2 radiculopathy treated by MCF were investigated retrospectively. The mean follow-up period was 24 months. Pre-operative symptoms, imaging studies including para-sagittal CT and MRI, rotational dynamic CT, and intraoperative findings were investigated. RESULTS There were 1 male and 2 females. The age of patients were ranged from 50 to 79 years. All cases had intractable occipito-cervical pain elicited by the cervical rotation. C2 nerve root block was temporally effective. There was unilateral spondylosis in symptomatic side without obvious atlatoaxial instability. Para-sagittal MRI and CT showed severe foraminal stenosis at C1-C2 due to the bony spur derived from the lateral atlanto-axial joints. In one case, dynamic rotational CT showed that the symptomatic foramen became narrower on rotational position. MCF was performed in all cases, and the C2 nerve root was impinged between the inferior edge of the C1 posterior arch and bony spur from the C1-C2 joint. After surgery, occipito-cervical pain disappeared. CONCLUSION This study demonstrated that mechanical impingement of the C2 nerve root is one of the causes of occipito-cervical pain and it was successfully treated by microscopic resection of the inferior edge of the C1 posterior arch. Para-sagittal CT and MRI, rotational dynamic CT, and nerve root block were effective for diagnosis.
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Affiliation(s)
- Yasushi Fujiwara
- Department of Orthopedic Surgery, Hiroshima City Asa Citizens Hospital, 2-1-1 Kabe-minami, Asa-kita-ku, Hiroshima, 731-0293, Japan.
| | - Bunichiro Izumi
- Department of Orthopedic Surgery, Hiroshima City Asa Citizens Hospital, 2-1-1 Kabe-minami, Asa-kita-ku, Hiroshima, 731-0293, Japan
| | - Masami Fujiwara
- Department of Orthopedic Surgery, Sada Hospital, Fukuoka, Japan
| | - Kazuyoshi Nakanishi
- Department of Orthopaedic Surgery, Institute of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Nobuhiro Tanaka
- Department of Orthopaedic Surgery, Institute of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Institute of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Hideki Manabe
- Department of Orthopedic Surgery, Hiroshima City Asa Citizens Hospital, 2-1-1 Kabe-minami, Asa-kita-ku, Hiroshima, 731-0293, Japan
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Ekşi MŞ, Toktaş ZO, Yılmaz B, Demir MK, Özcan-Ekşi EE, Bayoumi AB, Yener Y, Akakın A, Konya D. Vertebral artery loops in surgical perspective. 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 2016; 25:4171-4180. [PMID: 27388018 DOI: 10.1007/s00586-016-4691-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 06/16/2016] [Accepted: 07/03/2016] [Indexed: 11/28/2022]
Abstract
PURPOSE Vertebral artery loop is a congenital or acquired anomaly. Vertebral artery loops are incidentally diagnosed during evaluation of neck problems and trauma. We aimed to present the incidence of VA loops using magnetic resonance angiography in consecutive patients and discuss epidemiological data including the gender, age, location, signs and symptoms, treatment approaches and outcomes of VA loops via analyzing literature. METHODS In the first leg of our two-legged study, consecutive patients were evaluated using magnetic resonance angiography to detect any medial loop of vertebral arteries. The study period was from October 2015 to March 2016. In the second leg, academic databases about medial loop of vertebral artery were screened. Case reports, case series, abstracts and references of relevant literature were searched manually to avoid any missing cases. RESULTS We evaluated 239 consecutive patients using magnetic resonance angiography. Twenty-one patients were excluded from the study due to inadequate image acquisition, aplastic vertebral artery and/or concomitant vertebral artery stenosis. Medial loop of V2 vertebral artery was observed in 13 patients (5.9 %): 9 with left, 2 with right and 2 with bilateral medial V2 loop. Patients with medial V2 loop were significantly older than patients with straight vertebral arteries (70.30 vs. 62.36, p = 0.028). In the literature analysis, VA loops were more commonly observed at V2 segment (90.5 %). Vertebral artery loops were mostly diagnosed at the 5th and 6th decades of life predominantly in females. The most common signs and symptoms were radiculopathy and/or neck pain, and signs and symptoms of vertebrobasilar insufficiency. CONCLUSIONS Concise pre-operative evaluation of the vertebral arteries is essential to avoid the injury of undiagnosed VA loops during surgery, which might result in catastrophic circumstances. Further evaluation of the vertebral arteries using MR angiography is required, especially in elder age, before cervical spine surgeries.
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Affiliation(s)
- Murat Şakir Ekşi
- Department of Orthopedic Surgery-Spine Center, University of California at San Francisco, Medical Center, 500 Parnassus Avenue MU320 West, San Francisco, CA, 94143-0728, USA.
| | - Zafer Orkun Toktaş
- Department of Neurosurgery, Bahçeşehir University Medical School, Istanbul, Turkey
| | - Baran Yılmaz
- Department of Neurosurgery, Bahçeşehir University Medical School, Istanbul, Turkey
| | - Mustafa Kemal Demir
- Department of Radiology, Bahçeşehir University Medical School, Istanbul, Turkey
| | - Emel Ece Özcan-Ekşi
- Department of Physical Medicine and Rehabilitation, Antalya Ataturk State Hospital, Antalya, Turkey
| | - Ahmed B Bayoumi
- Department of Neurosurgery, Bahçeşehir University Medical School, Istanbul, Turkey
| | - Yasin Yener
- Department of Anesthesiology, Medical Park Göztepe Hospital, Istanbul, Turkey
| | - Akın Akakın
- Department of Neurosurgery, Bahçeşehir University Medical School, Istanbul, Turkey
| | - Deniz Konya
- Department of Neurosurgery, Bahçeşehir University Medical School, Istanbul, Turkey
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Abstract
Occipital neuralgia is defined by the International Headache Society as paroxysmal shooting or stabbing pain in the dermatomes of the greater or lesser occipital nerve. Various treatment methods exist, from medical treatment to open surgical procedures. Local injection with corticosteroid can improve symptoms, though generally only temporarily. More invasive procedures can be considered for cases that do not respond adequately to medical therapies or repeated injections. Radiofrequency lesioning of the greater occipital nerve can relieve symptoms, but there is a tendency for the pain to recur during follow-up. There also remains a substantial group of intractable patients that do not benefit from local injections and conventional procedures. Moreover, treatment of occipital neuralgia is sometimes challenging. More invasive procedures, such as C2 gangliotomy, C2 ganglionectomy, C2 to C3 rhizotomy, C2 to C3 root decompression, neurectomy, and neurolysis with or without sectioning of the inferior oblique muscle, are now rarely performed for medically refractory patients. Recently, a few reports have described positive results following peripheral nerve stimulation of the greater or lesser occipital nerve. Although this procedure is less invasive, the significance of the results is hampered by the small sample size and the lack of long-term data. Clinicians should always remember that destructive procedures carry grave risks: once an anatomic structure is destroyed, it cannot be easily recovered, if at all, and with any destructive procedure there is always the risk of the development of painful neuroma or causalgia, conditions that may be even harder to control than the original complaint.
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Affiliation(s)
- Il Choi
- Department of Neurological Surgery, Dongtan Sacred Heart Hospital, University of Hallym University, Hwaseong, Korea
| | - Sang Ryong Jeon
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Guha D, Mohanty C, Tator CH, Shamji MF. Occipital neuralgia secondary to unilateral atlantoaxial osteoarthritis: Case report and review of the literature. Surg Neurol Int 2016; 6:186. [PMID: 26759731 PMCID: PMC4697204 DOI: 10.4103/2152-7806.172531] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Accepted: 10/10/2015] [Indexed: 11/20/2022] Open
Abstract
Background: Atlantoaxial osteoarthritis (AAOA), either in isolation or in the context of generalized peripheral or spinal arthritis, presents most commonly with neck pain and limitation of cervical rotational range of motion. Occipital neuralgia (ON) is only rarely attributed to AAOA, as fewer than 30 cases are described in the literature. Case Description: A 64-year-old female presented with progressive incapacitating cervicalgia and occipital headaches, refractory to medications, and local anesthetic blocks. Computed tomography and magnetic resonance imaging studies documented advanced unilateral atlantoaxial arthrosis with osteophytic compression that dorsally displaced the associated C2 nerve root. Surgical decompression and atlantoaxial fusion achieved rapid and complete relief of neuralgia. Ultimately, postoperative spinal imaging revealed osseous union. Conclusions: Atlantoaxial arthrosis must be considered in the differential diagnosis of ON. Surgical treatment is effective for managing refractory cases. Intraoperative neuronavigation is also a useful adjunct to guide instrumentation and the intraoperative extent of bony decompression.
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Affiliation(s)
- Daipayan Guha
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Chandan Mohanty
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Charles H Tator
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Mohammed F Shamji
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
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Aberrant posterior inferior cerebellar artery injury with C1 lateral mass screw placement: a case report and review of the literature. Spine J 2014; 14:e7-14. [PMID: 24534389 DOI: 10.1016/j.spinee.2014.02.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Revised: 12/17/2013] [Accepted: 02/05/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Complications associated with C1 lateral mass screw placement are relatively infrequent. The most commonly feared complications include neural or vascular injury. Although both vertebral artery and internal carotid artery injuries have been discussed in the literature, there have been no reports of posterior inferior cerebellar artery (PICA) injury from C1 lateral mass screw placement. We report a case of patient who had a cerebellar stroke after C1 lateral mass screw placement, secondary to injury of an aberrant PICA. PURPOSE To describe the normal anatomy of the PICA, the anatomic variations previously reported in the literature, the sequela and symptoms of a patient with PICA injury, and the relevance to C1 lateral mass screw placement. No previous reports of PICA injury with a cerebellar stroke have been reported with C1 lateral mass screw instrumentation. STUDY DESIGN Case report and literature review. METHODS The patient underwent an Occiput-C6 posterior instrumentation for a pathologic fracture, secondary to multiple myeloma. In the postoperative period, the patient was found to have dysarthria, imbalance, and dysdiadochokinesia. Urgent computed tomography confirmed well placed C1 lateral mass screws. Magnetic resonance imaging/Magnetic Resonance Angiography showed an infarct in the PICA distribution with an abnormal variant of the PICA coursing extracranially around C1. Neurologic monitoring did not detect the injury intraoperatively. RESULTS The patient was treated with anticoagulation and he made a reasonable recovery from his stroke. CONCLUSIONS We report the first case of an aberrant PICA injured during a C1 lateral mass screw placement, resulting in a cerebellar stroke. Consideration should be given to abnormal PICA variation when placing C1 lateral mass screws.
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Sellin JN, Al-Hafez B, Duckworth EAM. Microvascular decompression of a C-2 segmental-type vertebral artery producing trigeminal hypesthesia. J Neurosurg 2014; 121:919-23. [PMID: 24972125 DOI: 10.3171/2014.5.jns131825] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The authors report a case of trigeminal hypesthesia caused by compression of the spinal cord by a C-2 segmental-type vertebral artery (VA) that was successfully treated with microvascular decompression. Aberrant intradural VA loops have been reported as causes of cervical myelopathy, some of which improved with microvascular decompression. A 52-year-old man presented with progressive complaints of headache, dizziness, left facial numbness, and left upper-extremity paresthesia that worsened when turning his head to the right. Magnetic resonance imaging of the cervical spine showed the left VA passing intradurally between the axis and atlas, foregoing the C-1 foramen transversarium, and impinging on the spinal cord. The patient underwent left C-1 and C-2 hemilaminectomies followed by microvascular decompression of an aberrant VA loop compressing the spinal cord. The patient subsequently reported complete resolution of symptoms.
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Affiliation(s)
- Jonathan N Sellin
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
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Shimizu S. [Scalp neuralgia and headache elicited by cranial superficial anatomical causes: supraorbital neuralgia, occipital neuralgia, and post-craniotomy headache]. Rinsho Shinkeigaku 2014; 54:387-94. [PMID: 24943074 DOI: 10.5692/clinicalneurol.54.387] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Most scalp neuralgias are supraorbital or occipital. Although they have been considered idiopathic, recent studies revealed that some were attributable to mechanical irritation with the peripheral nerve of the scalp by superficial anatomical cranial structures. Supraorbital neuralgia involves entrapment of the supraorbital nerve by the facial muscle, and occipital neuralgia involves entrapment of occipital nerves, mainly the greater occipital nerve, by the semispinalis capitis muscle. Contact between the occipital artery and the greater occipital nerve in the scalp may also be causative. Decompression surgery to address these neuralgias has been reported. As headache after craniotomy is the result of iatrogenic injury to the peripheral nerve of the scalp, post-craniotomy headache should be considered as a differential diagnosis.
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Affiliation(s)
- Satoru Shimizu
- Department of Neurosurgery, Yokohama Stroke and Brain Center
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Tandon A, Chandela S, Langer D, Sen C. A novel sling technique for microvascular decompression of a rare anomalous vertebral artery causing cervical radiculopathy. Neurosurg Focus 2014; 35:E2. [PMID: 23991815 DOI: 10.3171/2013.6.focus1339] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Cervical radiculopathy secondary to compression from congenital anomalous vertebral arteries (VAs) is a known entity. Patients present with a variety of symptoms ranging from upper-extremity numbness to true occipital neuralgia. Treatment options for extracranial tortuous VAs include conservative management or some form of surgical microvascular decompression (MVD). The authors report on a patient with a congenital anomalous VA loop causing cervical nerve root compression. Successful MVD was conducted with relief of the patient's symptoms. A novel sling technique was used for mobilization of the VA. To the authors' knowledge, this is the first MVD described utilizing this technique.
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Affiliation(s)
- Adesh Tandon
- Department of Neurosurgery, Albert Einstein College of Medicine, Bronx, New York 10467, USA.
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Ipekdal HI, Yiğitoğlu PH, Eker A, Ozmenoğlu M. Occipital neuralgia as an unusual manifestation of herpes zoster infection of the lesser occipital nerve: a case report. Acta Neurol Belg 2013; 113:201-2. [PMID: 22975833 DOI: 10.1007/s13760-012-0126-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Accepted: 08/08/2012] [Indexed: 01/12/2023]
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Hage ZA, Amin-Hanjani S, Wen D, Charbel FT. Surgical management of cervical radiculopathy caused by redundant vertebral artery loop. J Neurosurg Spine 2012; 17:337-41. [PMID: 22900507 DOI: 10.3171/2012.7.spine123] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
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.
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Affiliation(s)
- Ziad A Hage
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois 60612, USA
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Lucchesi C, Puglioli M, Gori S. Occipital neuralgia: a symptomatic case caused by an abnormal left vertebral artery. Neurol Sci 2012; 34:243-5. [PMID: 22311642 DOI: 10.1007/s10072-012-0964-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Accepted: 01/23/2012] [Indexed: 11/29/2022]
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Pisapia JM, Bhowmick DA, Farber RE, Zager EL. Salvage C2 Ganglionectomy After C2 Nerve Root Decompression Provides Similar Pain Relief as a Single Surgical Procedure for Intractable Occipital Neuralgia. World Neurosurg 2012; 77:362-9. [DOI: 10.1016/j.wneu.2011.06.062] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2011] [Revised: 05/07/2011] [Accepted: 06/24/2011] [Indexed: 10/15/2022]
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Chibbaro S, Mirone G, Yasuda M, Marsella M, Di Emidio P, George B. Vertebral artery loop--a cause of cervical radiculopathy. World Neurosurg 2011; 78:375.e11-3. [PMID: 22381311 DOI: 10.1016/j.wneu.2011.12.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2011] [Revised: 10/24/2011] [Accepted: 12/01/2011] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To report a case of cervical radiculopathy caused by an anomalous vertebral artery (VA) and illustrate the efficacy of microvascular decompression by the anterolateral approach. METHODS A 50-year-old woman was referred because of an 8-year history of progressive left C6 radiculopathy refractory to other forms of treatment, including C5-6 anterior cervical discectomy. Clinical and radiologic evaluation showed an abnormally tortuous loop of V2 causing direct neurovascular compression. RESULTS A left cervical anterolateral approach was used to expose the anomalous loop. After a generous bony decompression, the loop was identified, and the artery was mobilized and ultimately separated from the C6 nerve root removing the direct pulsatile compression. CONCLUSIONS Cervical root compression by an aberrant or anomalous extracranial VA is a rare cause of radiculopathy. The best management of such lesions is the anterolateral approach with bony and direct microvascular decompression.
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Affiliation(s)
- Salvatore Chibbaro
- Department of Neurosurgery, Laribosiere University Hospital, Paris, France.
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Sierra-Hidalgo F, Ruíz J, Morales-Cartagena A, Martínez-Salio A, Serna JDL, Hernández-Gallego J. Infiltrative cervical lesions causing symptomatic occipital neuralgia. Cephalalgia 2011; 31:1493-6. [DOI: 10.1177/0333102411418693] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Occipital neuralgia is a well-recognized cause of posterior head and neck pain that may associate mild sensory changes in the cutaneous distribution of the occipital nerves, lacking a recognizable local structural aetiology in most cases. Atypical clinical features or an abnormal neurological examination are alerts for a potential underlying cause of pain, although cases of clinically typical occipital neuralgia as isolated manifestation of lesions of the cervical spinal cord, cervical roots, or occipital nerves have been increasingly reported. Case reports: We describe two cases (one with typical and another one with atypical clinical features) of occipital neuralgia secondary to paravertebral pyomyositis and vertebral relapse of multiple myeloma in patients with relevant medical history that aroused the possibility of an underlying structural lesion. Discussion: We discuss the need for cranio-cervical magnetic resonance imaging in all patients with occipital neuralgia, even when typical clinical features are present and neurological examination is completely normal.
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Affiliation(s)
| | - J Ruíz
- Hospital Universitario 12 de Octubre, Spain
| | | | | | | | - J Hernández-Gallego
- Hospital Universitario 12 de Octubre, Spain
- Universidad Complutense of Madrid, Spain
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Trimble C, Reeves A, Pare L, Tsai F. Vertebral artery anomaly causing C2 suboccipital neuralgia, relieved by neurovascular decompression. J Neuroimaging 2011; 23:421-4. [PMID: 21682793 DOI: 10.1111/j.1552-6569.2011.00602.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
We report imaging and surgical findings of a symptomatic 40-year-old male with an anomalous left vertebral artery. MR, CT myelography, angiography, and intraoperative photos demonstrate the vertebral artery entering the thecal sac at the C1-C2 intervertebral foramen and compressing the dorsal C2 nerve rootlets against the cord. Open microvascular decompression alleviated the patient's long-standing suboccipital and posterior cervical neck pain. An embryologic review of the vertebral and lateral spinal artery systems reveals possible developmental explanations for this variant. Intradural course of the vertebral artery at C2 is one of the few symptomatic developmental vertebral artery anomalies. Recognition of this condition is important because surgical intervention can alleviate associated neck pain.
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Affiliation(s)
- Christopher Trimble
- Sacred Heart Medical Center - Transitional Year Residency Program, Spokane, WA 99220-2555, USA.
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Pakzaban P. Transarticular screw fixation of C1-2 for the treatment of arthropathy-associated occipital neuralgia. J Neurosurg Spine 2011; 14:209-14. [PMID: 21214317 DOI: 10.3171/2010.10.spine09815] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Two patients with occipital neuralgia due to severe arthropathy of the C1-2 facet joint were treated using atlantoaxial fusion with transarticular screws without decompression of the C-2 nerve root. Both patients experienced immediate postoperative relief of occipital neuralgia. The resultant motion elimination at C1-2 eradicated not only the movement-evoked pain, but also the paroxysms of true occipital neuralgia occurring at rest. A possible pathophysiological explanation for this improvement is presented in the context of the ignition theory of neuralgic pain. This represents the first report of C1-2 transarticular screw fixation for the treatment of arthropathy-associated occipital neuralgia.
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Kim HS, Lee JH, Cheh G, Lee SH. Cervical radiculopathy caused by vertebral artery loop formation : a case report and review of the literature. J Korean Neurosurg Soc 2010; 48:465-8. [PMID: 21286489 DOI: 10.3340/jkns.2010.48.5.465] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2010] [Revised: 09/13/2010] [Accepted: 11/22/2010] [Indexed: 11/27/2022] Open
Abstract
Vertebral artery loop formation causing encroachment on cervical neural foramen and canal is a rare cause of cervical radiculopathy. We report a case of 61-year-old woman with vertebral artery loop formation who presented with right shoulder pain radiating to her arm for 2 years. Plain radiograph and computed tomography scan revealed widening of the right intervertebral foramen at the C5-6 level. Magnetic resonance imaging and angiogram confirmed the vertebral artery loop formation compressing the right C6 nerve root. We had considered microdecompressive surgery, but the patient's symptoms resolved after conservative management. Clinician should keep in mind that vertebral artery loop formation is one of important causes of cervical radiculopathy. Vertebral artery should be visualized using magnetic resonance angiography in suspected case.
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Affiliation(s)
- Hoon Soo Kim
- Department of Neurosurgery, Busan Wooridul Spine Hospital, Busan, Korea
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Cornely C, Fischer M, Ingianni G, Isenmann S. Greater Occipital Nerve Neuralgia Caused by Pathological Arterial Contact: Treatment by Surgical Decompression. Headache 2010; 51:609-12. [DOI: 10.1111/j.1526-4610.2010.01802.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Park YS, Kang DH, Park KB, Hwang SH. Posterior atlantoaxial screw-rod fixation in a case of aberrant vertebral artery course combined with bilateral high-riding vertebral artery. J Korean Neurosurg Soc 2010; 48:367-70. [PMID: 21113368 DOI: 10.3340/jkns.2010.48.4.367] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2009] [Revised: 04/25/2010] [Accepted: 10/04/2010] [Indexed: 11/27/2022] Open
Abstract
We present a case of posterior atlantoaxial screw-rod fixation in a patient with an aberrant vertebral artery (VA) course combined with bilateral high-riding VA. An aberrant VA which courses below the posterior arch of the atlas (C1) that does not pass through the C1 transverse foramen and without an osseous anomaly is rare. However, it is important to consider an abnormal course of the VA both preoperatively and intraoperatively in order to avoid critical vascular injuries in procedures which require exposure or control of the VA, such as the far-lateral approach and spinal operations.
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Affiliation(s)
- Young Seop Park
- Department of Neurosurgery, Gyeongsang National University School of Medicine, Jinju, Korea
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Abstract
Occipital neuralgia is defined as a paroxysmal shooting or stabbing pain in the dermatomes of the nervus occipitalis major and/or nervus occipitalis minor. The pain originates in the suboccipital region and radiates over the vertex. A suggestive history and clinical examination with short-term pain relief after infiltration with local anesthetic confirm the diagnosis. No data are available about the prevalence or incidence of this condition. Most often, trauma or irritation of the nervi occipitales causes the neuralgia. Imaging studies are necessary to exclude underlying pathological conditions. Initial therapy consists of a single infiltration of the culprit nervi occipitales with local anesthetic and corticosteroids (2 C+). The reported effects of botulinum toxin A injections are contradictory (2 C+/-). Should injection of local anesthetic and corticosteroids fail to provide lasting relief, pulsed radio-frequency treatment of the nervi occipitales can be considered (2 C+). There is no evidence to support pulsed radio-frequency treatment of the ganglion spinale C2 (dorsal root ganglion). As such, this should only be done in a clinical trial setting. Subcutaneous occipital nerve stimulation can be considered if prior therapy with corticosteroid infiltration or pulsed radio-frequency treatment failed or provided only short-term relief (2 C+).
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Affiliation(s)
- Pascal Vanelderen
- Department of Anesthesiology and Pain Management, Ziekenhuis Oost-Limburg, Genk, Belgium
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Bogduk N, Govind J. Cervicogenic headache: an assessment of the evidence on clinical diagnosis, invasive tests, and treatment. Lancet Neurol 2009; 8:959-68. [PMID: 19747657 DOI: 10.1016/s1474-4422(09)70209-1] [Citation(s) in RCA: 201] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Cervicogenic headache is characterised by pain referred to the head from the cervical spine. Although the International Headache Society recognises this type of headache as a distinct disorder, some clinicians remain sceptical. Laboratory and clinical studies have shown that pain from upper cervical joints and muscles can be referred to the head. Clinical diagnostic criteria have not proved valid, but a cervical source of pain can be established by use of fluoroscopically guided, controlled, diagnostic nerve blocks. In this Review, we outline the basic science and clinical evidence for cervicogenic headache and indicate how opposing approaches to its definition and diagnosis affect the evidence for its clinical management. We provide recommendations that enable a pragmatic approach to the diagnosis and management of probable cervicogenic headache, as well as a rigorous approach to the diagnosis and management of definite cervical headache.
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Affiliation(s)
- Nikolai Bogduk
- Newcastle Bone and Joint Institute, Royal Newcastle Centre, New South Wales, Australia.
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White JB, Atkinson PP, Cloft HJ, Atkinson JLD. Vascular Compression as a Potential Cause of Occipital Neuralgia: A Case Report. Cephalalgia 2007; 28:78-82. [DOI: 10.1111/j.1468-2982.2007.01427.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Vascular compression is a well-established cause of cranial nerve neuralgic syndromes. A unique case is presented that demonstrates that vascular compression may be a possible cause of occipital neuralgia. A 48-year-old woman with refractory left occipital neuralgia revealed on magnetic resonance imaging and computed tomographic imaging of the upper cervical spine an atypically low loop of the left posterior inferior cerebellar artery (PICA), clearly indenting the dorsal upper cervical roots. During surgery, the PICA loop was interdigitated with the C1 and C2 dorsal roots. Microvascular decompression alone has never been described for occipital neuralgia, despite the strong clinical correlation in this case. Therefore, both sectioning the dorsal roots of C2 and microvascular decompression of the PICA loop were performed. Postoperatively, the patient experienced complete cure of her neuralgia. Vascular compression as a cause of refractory occipital neuralgia should be considered when assessing surgical options.
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Affiliation(s)
| | | | - HJ Cloft
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
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Shimizu S, Oka H, Osawa S, Fukushima Y, Utsuki S, Tanaka R, Fujii K. Can proximity of the occipital artery to the greater occipital nerve act as a cause of idiopathic greater occipital neuralgia? An anatomical and histological evaluation of the artery-nerve relationship. Plast Reconstr Surg 2007; 119:2029-2034. [PMID: 17519696 DOI: 10.1097/01.prs.0000260588.33902.23] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The purpose of this study was to clarify whether proximity of the occipital artery to the greater occipital nerve can act as a cause of occipital neuralgia, analogous to the contribution of intracranial vessels due to compression in cranial nerve neuralgias, represented by trigeminal neuralgias due to compression of the trigeminal nerve root by adjacent arterial loops. METHODS Twenty-four suboccipital areas in cadaver heads were studied for anatomical relationships between the occipital artery and the greater occipital nerve, with histopathological assessment of the greater occipital nerve for signs of mechanical damage. RESULTS The occipital artery and greater occipital nerve were found to cross each other in the nuchal subcutaneous layer, and the latter was constantly situated superficial to the former at the cross point. An indentation of the greater occipital nerve due to the occipital artery was observed at the cross point in all specimens. However, histopathological examination did not reveal any findings of damage to nerves, even in specimens with atherosclerosis of the occipital artery. CONCLUSIONS Although the present study did not provide direct evidence that the occipital artery contributes to occipital neuralgia at the point of contact with the greater occipital nerve, the possibility still cannot be precluded, because the occipital artery may be palpable in areas corresponding to tenderness of the greater occipital nerve. Further studies, including clinical cases, are needed to clarify this issue.
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Affiliation(s)
- Satoru Shimizu
- Sagamihara and Kawasaki, Kanagawa, Tokyo From the Department of Neurosurgery, Kitasato University School of Medicine, and Tanaka Clinic
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Uhl E, Brückmann H, Goetz C. Congestion of epidural venous plexus secondary to vertebral artery occlusion mimicking a herniated cervical disc. Clin Neurol Neurosurg 2007; 109:357-60. [PMID: 17222506 DOI: 10.1016/j.clineuro.2006.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2006] [Revised: 12/06/2006] [Accepted: 12/08/2006] [Indexed: 11/24/2022]
Abstract
Vascular abnormalities or dissection of the vertebral artery are rare causes for cervical monoradiculopathy. We present the case of a 44-year-old female patient with a short history of radiculopathy of the right C5 root with radicular pain and a severe motor deficit. CT-imaging showed a hyperdense structure at the C4/C5 level suggesting a herniated disc. Because of the neurological deficit the patient was operated by a dorsal approach. Intraoperatively no herniated disc but only a congested epidural venous plexus was found. Postoperative MRI and angiography showed occlusion of the vertebral artery from C3 to C6 level probably due to dissection. The present case shows that a CT-study suggestive for a herniated disc can be misleading. Enlargement of the vertebral artery secondary to dissection or occlusion may lead to compression of the venous plexus which resembles disc material on CT-scan.
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Affiliation(s)
- Eberhard Uhl
- Department of Neurosurgery, Klinikum Grosshadern, Ludwig-Maximilians-University, Marchioninistr. 15, D-81377 Munich, Germany.
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Ashley WW, Chicoine MR. Subarachnoid hemorrhage caused by posterior inferior cerebellar artery aneurysm with an anomalous course of the atlantoaxial segment of the vertebral artery. J Neurosurg 2005; 103:356-60. [PMID: 16175868 DOI: 10.3171/jns.2005.103.2.0356] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
✓ Various anatomical courses of the vertebral artery (VA) and posterior inferior cerebellar artery (PICA) have been described. The authors present a unique case of a subarachnoid hemorrhage resulting from an aneurysm in a patient with an anatomical variation of the extracranial portion of the VA and cervical origin of the PICA. The surgical implications of this variant are discussed, and the pertinent literature reviewed. Subarachnoid hemorrhage caused by rupture of a PICA aneurysm is reported for the first time in association with a rare variation of the course of the VA.
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Affiliation(s)
- William W Ashley
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
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Hott JS, Lynch JJ, Chamberlain RH, Sonntag VKH, Crawford NR. Biomechanical comparison of C1–2 posterior fixation techniques. J Neurosurg Spine 2005; 2:175-81. [PMID: 15739530 DOI: 10.3171/spi.2005.2.2.0175] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Object. In a nondestructive, repeated-measures in vitro flexibility experiment, the authors compared the acute stability of C1–2 after placement of C-1 lateral mass and C-2 pars interarticularis (LC1—PC2) instrumentation with that of C1–2 transarticular screw fixation.
Methods. The effect of C-1 laminectomy and C1–2 interspinous cable/graft fixation on LC1—PC2 stability was studied. Screw pullout strengths were also compared. Seven human cadaveric occiput—C3 specimens were loaded nondestructively with pure moments while measuring nonconstrained atlantoaxial motion. Specimens were tested with graft alone, LC1—PC2 alone, LC1—PC2 combined with C-1 laminectomy, and graft-augmented LC1—PC2. Interspinous cable/graft fixation significantly enhanced LC1—PC2 stability during extension. After C-1 laminectomy, the LC1—PC2 construct allowed increased motion during flexion and extension. There was no significant difference in lax zone or range of motion between LC1—PC2 fixation and transarticular screw fixation, but graft-assisted transarticular screws yielded a significantly smaller stiff zone during extension. The difference in pullout resistance between C-1 lateral mass screws and C-2 pars interarticularis screws was insignificant. The LC1—PC2 region restricted motion to within the normal range during all loading modes. Atlantal laminectomy reduced LC1—PC2 stability during flexion and extension.
Conclusions. The instrumentation-augmented LC1—PC2 construct performed biomechanically similarly to the C1–2 transarticular screw fixation. The LC1—PC2 construct resisted flexion, lateral bending, and axial rotation well. The weakness of the LC1—PC2 fixation in resisting extension can be overcome by adding an interspinous graft to the construct.
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Affiliation(s)
- Jonathan S Hott
- Division of Neurological Surgery and Spinal Biomechanics Research Laboratory, Barrow Neurological Institute, St Joseph's Hospital and Medical Center, Phoenix, Arizona 85013, USA
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Ganiyusufoglu K, Kantarci M, Sirvanci M, Sildiroglu O, Alparslan L. Cervical Radiculopathy Caused by Vertebral Artery Loop Formation. J Comput Assist Tomogr 2005; 29:133-5. [PMID: 15665700 DOI: 10.1097/01.rct.0000146481.56700.da] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Vertebral artery tortuosity and loop formation are rare causes of cervical radiculopathy. The criterion standard for the detection of vertebral artery loop formation is digital subtraction angiography. Computed tomography (CT) and magnetic resonance imaging provide good accuracy in the evaluation of vertebral arteries. A case of vertebral artery loop formation is reported. The diagnosis was confirmed by 16-row multisection CT angiography findings of vertebral artery loop formation.
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Affiliation(s)
- Kursat Ganiyusufoglu
- Department of Radiology, Florence Nightingale Hospital, Kadir Has University School of Medicine, Istanbul, Turkey
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Abstract
Referred pain from disorders of the cervical spine can be perceived as headache. The mechanism is convergence between trigeminal afferents and afferents of the upper three cervical nerves in the trigeminocervical nucleus. Cervicogenic headache cannot be diagnosed on clinical grounds alone. The definitive criterion is complete relief of pain after controlled diagnostic blocks of cervical structures or their nerve supply. The most rigorously studied example of cervicogenic headache is third occipital headache.
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Affiliation(s)
- Nikolai Bogduk
- University of Newcastle, Department of Clinical Research, Royal Newcastle Hospital, Newcastle, NSW 2300, Australia.
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Takahashi T, Tominaga T, Hassan T, Yoshimoto T. Cervical cord compression with myelopathy caused by bilateral persistence of the first intersegmental arteries: case report. Neurosurgery 2003; 53:234-7; discussion 237. [PMID: 12823896 DOI: 10.1227/01.neu.0000069537.22198.50] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2002] [Accepted: 03/11/2003] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE AND IMPORTANCE Cervical myelopathy induced by vascular compression is rare. We report a case caused by bilateral persistence of the first intersegmental arteries (a vertebral artery anomaly). Myelopathy was successfully treated with vascular decompression. CLINICAL PRESENTATION A 66-year-old woman presented with gradually worsening paroxysmal neck and arm pain. Magnetic resonance imaging and angiography demonstrated anomalous intradural courses of both vertebral arteries, compressing the dorsal aspect of the cervical spinal cord. INTERVENTION Microvascular decompression was performed with transposition of the arteries, followed by anchoring of the arteries to the dorsolateral dura mater with Gore-Tex bands (W.L. Gore & Associates, Inc., Flagstaff, AZ). CONCLUSION The pain disappeared promptly after surgery. Surgical decompression, with anchoring of an anomalous vertebral artery to the dura, can relieve pain and other symptoms resulting from vascular cord compression.
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Paksoy Y, Levendoglu FD, Ogün CO, Ustün ME, Ogün TC. Vertebral artery loop formation: a frequent cause of cervicobrachial pain. Spine (Phila Pa 1976) 2003; 28:1183-8. [PMID: 12782990 DOI: 10.1097/01.brs.0000067275.08517.58] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Patients with cervicobrachial pain were examined in detail with special attention to vertebral artery loop formation. OBJECTIVES To determine the incidence, short-time natural course and response to a conservative approach to vertebral artery loop formation in a group of patients with cervicobrachial pain. SUMMARY OF THE BACKGROUND DATA Vertebral artery loop formation is reported to be a rare cause of cervicobrachial neuralgia, discovered incidentally during the search for its cause. It can be congenital or acquired, occurring equally in both sexes. Surgical decompression has been the preferred method in the majority of reported cases, with favorable results. METHODS One hundred seventy-three patients with cervicobrachial pain were examined in a period of 7 months using physical examination, radiography, and magnetic resonance imaging with or without angiography. RESULTS Thirteen patients with a mean age of 43.9 +/- 13.5 years were diagnosed with vertebral artery loop formation. The most common level was C6-C7. Four patients presented with loop formation at two levels. None of the patients had symptoms attributable to intervertebral disc pathology. The complaints were in accordance with the level of the vascular pathology. Complete relief or decrease in pain was observed in all patients with the conservative approach. CONCLUSIONS In patients with cervicobrachialgic symptoms and without established discopathy, during the examination of sagittal magnetic resonance images, vertebral artery loop formation should be kept in mind, and in suspected cases, the vertebral artery should be visualized using three-dimensional time of flight magnetic resonance angiography. Vertebral artery-nerve root relation should also be demonstrated using the multiplanar reformatting method from time of flight images. A conservative course of treatment has a favorable outcome.
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Affiliation(s)
- Yahya Paksoy
- Ultra Imaging Center, Selçuk University Medical School, Konya, Turkey
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Wang MY, Levi ADO. Ganglionectomy of C-2 for the treatment of medically refractory occipital neuralgia. Neurosurg Focus 2002; 12:E14. [PMID: 16212327 DOI: 10.3171/foc.2002.12.1.15] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Occipital neuralgia is a result of neuropathic pain transmission in the distribution of the greater occipital nerve. Because it is well anatomically localized, occipital neuralgia has been the focus of various surgical treatments. Ablation, decompression, and modulation of the C-2 nerve have all been described as effective treatments. The C-2 dorsal root ganglionectomy provides effective treatment for this disorder with a low incidence of unpleasant side effects. In this review the authors summarize the current treatment of occipital neuralgia.
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Affiliation(s)
- Michael Y Wang
- Department of Neurosurgery, University of Miami School of Medicine, Miami, Florida, USA.
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