Skip to main content
SpringerLink
Log in

Three-dimensional computed tomography angiographic study of the vertebral artery in patients with congenital craniovertebral junction anomalies

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Purpose

To describe vertebral artery (VA) course at the C0–C1–C2 complex in patients with congenital bony craniovertebral junction (CVJ) anomalies.

Methods

We studied the course of 169 VAs in 86 patients with congenital bony CVJ anomalies [basilar invagination (42), os odontoideum (33), and irreducible atlantoaxial dislocation (11)]. Occipitalized atlas occurred in 41 patients (30 complete and 11 partial). Using axial, coronal and sagittal three-dimensional computed tomography (3D-CT) angiograms, we traced the VA bilaterally at the CVJ and correlated the course to the presence or absence of occipitalization of the atlas.

Results

Of the 73 arteries associated with occipitalization of atlas, all had an abnormal course—58 (78.4 %) coursed through a canal within the C0–C1 fused complex and 15 (20.3 %) coursed below the C1 posterior arch, and it was absent unilaterally in one patient. There were 96 arteries associated with a non-occipitalized atlas and only 15 (15.3 %) were abnormal—eight coursed below the C1 posterior arch, four coursed above the C1 arch in the absence of a C1 foramen transversarium, one passed through a canal in C0–C1 and two arteries were absent unilaterally. Sixty vertebral arteries (34 on the right and 26 on the left side) had a redundant loop situated at a distance of ≥5 mm from the C1 lateral mass in patients with os odontoideum and irreducible atlantoaxial dislocation.

Conclusions

In occipitalization of the atlas, the VA course is usually abnormal—typically passing through a canal within the C0–C1 fused complex or below the C1 arch. A redundant VA loop is more likely to be seen in os odontoideum and irreducible atlantoaxial dislocation. Careful study of the vertebral artery course with 3D CT angiography is mandatory while contemplating CVJ realignment surgery in congenital anomalies of the CVJ.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

References

  1. Chandra PS, Goyal N, Chauhan A, Ansari A, Sharma BS, Garg A (2014) The severity of basilar invagination and atlantoaxial dislocation correlates with sagittal joint inclination, coronal joint inclination and craniocervical tilt: a description of new indexes for the craniovertebral junction. Neurosurgery 10(4 suppl):621–630

    Article  PubMed  Google Scholar 

  2. Daniel RT, Chacko AG (2008) Craniovertebral junction realignment and fusion through a posterior approach in the treatment of basilar invagination. Spine: Affiliated Society Meeting Abstracts, pp 133–135 (Abstract)

  3. Daniel RT, Muzumdar A, Ingalhalikar A, Moldavsky M, Khalil S (2012) Biomechanical stability of a posterior-alone fixation technique after craniovertebral junction realignment. World Neurosurg 77:357–361

    Article  PubMed  Google Scholar 

  4. Goel A (2004) Treatment of basilar invagination by atlantoaxial joint distraction and direct lateral mass fixation. J Neurosurg Spine 1:281–286

    Article  PubMed  Google Scholar 

  5. Goel A, Kulkarni AG, Sharma P (2005) Reduction of fixed atlantoaxial dislocation in 24 cases: technical note. J Neurosurg Spine 2:505–509

    Article  PubMed  Google Scholar 

  6. Madawi AA, Casey ATH, Solanki GA, Tuite G, Veres R, Crockard HA (1997) Radiological and anatomical evaluation of the atlantoaxial transarticular screw fixation technique. J Neurosurg 86:961–968

    Article  CAS  PubMed  Google Scholar 

  7. Abou-Madawi A, Solanki G, Casey AT, Crockard HA (1997) Variation of the groove in the axis vertebra for the vertebral artery: implications for instrumentation. J Bone Joint Surg Br 79:820–823

    Article  CAS  PubMed  Google Scholar 

  8. Cacciola F, Phalke U, Goel A (2004) Vertebral artery in relationship to C1–C2 vertebrae: an anatomical study. Neurol India 52:178–184

    PubMed  Google Scholar 

  9. Paramore CG, Dickman CA, Sonntag VK (1996) The anatomical suitability of the C1–2 complex for transarticular screw fixation. J Neurosurg 85:221–224

    Article  CAS  PubMed  Google Scholar 

  10. Sardhara J, Behari S, Mohan BM, Jaiswal AK, Sahu RN, Srivastava A, Mehrotra A, Lal H (2015) Risk stratification of vertebral artery vulnerability during surgery for congenital atlanto-axial dislocation with or without an occipitalized atlas. Neurol India 63:382–391

    Article  PubMed  Google Scholar 

  11. Tubbs RS, Salter EG, Oakes WJ (2006) The intracranial entrance of the atlantal segment of the vertebral artery in crania with occipitalization of the atlas. J Neurosurg Spine 4:319–322

    Article  PubMed  Google Scholar 

  12. Wang S, Wang C, Liu Y, Yan M, Zhou H (2009) Anomalous vertebral artery in craniovertebral junction with occipitalization of the atlas. Spine (Phila Pa 1976) 34:2838–2842

  13. Yamazaki M, Okawa A, Furuya T, Sakuma T, Takahashi H, Kato K, Fujiyoshi T, Mannoji C, Takahashi K, Koda M (2012) Anomalous vertebral arteries in the extra and intraosseous regions of the craniovertebral junction visualized by 3-dimensional computed tomographic angiography: analysis of 100 consecutive surgical cases and review of the literature. Spine (Phila Pa 1976) 37:1389–1397

  14. Coric D, Branch CL Jr, Wilson JA, Robinson JC (1996) Arteriovenous fistula as a complication of C1–C2 transarticular screw fixation: case report and review of the literature. J Neurosurg 85:340–343

    Article  CAS  PubMed  Google Scholar 

  15. Sanelli PC, Tong S, Gonzalez RG, Eskey CJ (2002) Normal variation of vertebral artery on CT angiography and its implications for diagnosis of acquired pathology. J Comput Assist Tomogr 26:462–470

    Article  PubMed  Google Scholar 

  16. Wright NM, Lauryssen C (1998) Vertebral artery injury in C1–2 transarticular screw fixation: results of a survey of the AANS/CNS section on disorders of the spine and peripheral nerves. J Neurosurg 88:634–640

    Article  CAS  PubMed  Google Scholar 

  17. Hong JT, Lee SW, Son BC, Sung JH, Yang SH, Kim IS, Park CK (2008) Analysis of anatomical variations of bone and vascular structures around the posterior atlantal arch using three-dimensional computed tomography angiography. J Neurosurg Spine. 8:230–236

    Article  PubMed  Google Scholar 

  18. Wakao N, Takeuchi M, Nishimura M, Riew KD, Kamiya M, Hirasawa A, Kawanami K, Imagama S, Sato K, Takayasu M (2014) Vertebral artery variations and osseous anomaly at the C1–2 level diagnosed by 3D CT angiography in normal subjects. Neuroradiology 56:843–849

    Article  PubMed  Google Scholar 

  19. Menezes AH (2008) Craniocervical developmental anatomy and its implications. Childs Nerv Syst 24:1109–1122

    Article  PubMed  Google Scholar 

  20. Burwood RJ, Watt I (1974) Assimilation of the atlas and basilar impression: a review of 1500 skull and cervical spine radiographs. Clin Radiol 25:327–333

    Article  CAS  PubMed  Google Scholar 

  21. Tokuda K, Miyasaka K, Abe H, Abe S, Takei H, Sugimoto S, Tsuru M (1985) Anomalous atlantoaxial portions of vertebral and posterior inferior cerebellar arteries. Neuroradiology 27:410–413

    Article  CAS  PubMed  Google Scholar 

  22. Sato K, Watanabe T, Yoshimoto T, Kameyama M (1994) Magnetic resonance imaging of C2 segmental type of vertebral artery. Surg Neurol 41:45–51

    Article  CAS  PubMed  Google Scholar 

  23. Mettler FA Jr, Huda W, Yoshizumi TT, Mahesh M (2008) Effective doses in radiology and diagnostic nuclear medicine: a catalog. Radiology 248:254–263

    Article  PubMed  Google Scholar 

  24. Yamazaki M, Okawa A, Hashimoto M, Aiba A, Someya Y, Koda M (2008) Abnormal course of the vertebral artery at the craniovertebral junction in patients with down syndrome visualized by three-dimensional CT angiography. Neuroradiology 50:485–490

    Article  PubMed  Google Scholar 

  25. Yamaguchi S, Eguchi K, Kiura Y, Takeda M, Kurisu K (2008) Posterolateral protrusion of the vertebral artery over the posterior arch of the atlas: quantitative anatomical study using three-dimensional computed tomography angiography. J Neurosurg Spine 9:167–174

    Article  PubMed  Google Scholar 

  26. Neo M, Matsushita M, Iwashita Y, Yasuda T, Sakamoto T, Nakamura T (2003) Atlantoaxial transarticular screw fixation for a high-riding vertebral artery. Spine (Phila Pa 1976) 28:666–670

  27. Young JP, Young PH, Ackermann MJ, Anderson PA, Riew KD (2005) The ponticulus posticus: implications for screw insertion into the first cervical lateral mass. J Bone Joint Surg Am 87:2495–2498

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurological Sciences, Christian Medical College, Vellore, India

    Laxminadh Sivaraju, Krishna Prabhu, Roy Thomas Daniel & Ari George Chacko

  2. Department of Radiodiagnosis, Christian Medical College, Vellore, India

    Sunithi Mani

Authors
  1. Laxminadh Sivaraju
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sunithi Mani
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Krishna Prabhu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Roy Thomas Daniel
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ari George Chacko
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Laxminadh Sivaraju.

Ethics declarations

Source of support

The authors have not received any support, in the form of grant, from any source for preparation of this article. Neither do the authors, nor does the institute have any personal or institutional financial interest in drugs, materials, or devices described in their submissions.

Disclosure

This paper has not been published before and has not been submitted for publication to any other journal in part or full.

Conflict of interest

The authors concur with this submission and there is no conflict of interest arising from this article.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sivaraju, L., Mani, S., Prabhu, K. et al. Three-dimensional computed tomography angiographic study of the vertebral artery in patients with congenital craniovertebral junction anomalies. Eur Spine J 26, 1028–1038 (2017). https://doi.org/10.1007/s00586-016-4580-7

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-016-4580-7

Keywords

Search

Navigation