Arterial Fencing: A Challenge During Complex Craniovertebral Junction Surgery

A 32-year-old woman presented with chronically progressive spastic quadriparesis. Detailed clinicoradiological evaluation led to the diagnosis of irreducible atlantoaxial dislocation and basilar invagination, with associated “kissing” carotids and an anomalous right vertebral artery (VA). Both inter...

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Bibliographic Details
Published in:World neurosurgery 2022-05, Vol.161, p.147-148
Main Authors: Das, Kuntal Kanti, Pattankar, Sanjeev, Srivastava, Arun Kumar
Format: Article
Language:English
Subjects:
Adult
Arterial fence
Atlanto-Axial Joint - diagnostic imaging
Atlanto-Axial Joint - surgery
Brachiocephalic Trunk
C3 segmental artery
Carotid Artery, Internal - diagnostic imaging
Carotid Artery, Internal - surgery
Complex craniovertebral anomaly
Female
Humans
Joint Dislocations - diagnostic imaging
Joint Dislocations - surgery
Kissing carotids
Platybasia
Spinal Fusion
Vascular Malformations
Vertebral Artery - diagnostic imaging
Vertebral Artery - surgery
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Summary:A 32-year-old woman presented with chronically progressive spastic quadriparesis. Detailed clinicoradiological evaluation led to the diagnosis of irreducible atlantoaxial dislocation and basilar invagination, with associated “kissing” carotids and an anomalous right vertebral artery (VA). Both internal carotid arteries had an abnormally tortuous course, “kissing” retropharyngeally at the level of C1-C2. The right VA became intradural at the level of C2-C3, an extremely rare anomaly—C3 segmental artery. Despite the deformed joints and the possibility of injuring the anomalous right VA during C2-C3 instrumentation, a tailored posterior-only approach was used to circumvent the arterial fence created by both vascular anomalies. The patient underwent bilateral C1-C2 joint opening and left C1-C2 joint spacer placement, followed by bilateral occipito-C3-C4 fixation. This is possibly the first reported case of a complex craniovertebral junction anomaly associated with both kissing carotids and a C3 segmental VA.
ISSN:1878-8750
1878-8769
DOI:10.1016/j.wneu.2022.02.111