Evaluation of vertebral artery anomaly in basilar invagination and prevention of vascular injury during surgical intervention: CTA features and analysis
To evaluate vertebral artery anomaly at the craniovertebral junction (CVJ) in patients with basilar invagination (BI) by computed tomographic angiography (CTA), and to discuss the prevention strategy of vascular injury.
The primary axial, multiple planar reconstruction and volume-rendering cervicocranial CTA images of 39 BI patients were analysed to evaluate vertebral artery anomaly at the CVJ: persistent first intersegmental artery (PFIA), fenestrated vertebral artery (FEN), and extracranial C1/2 origin of posterior inferior cerebellar artery (PICA), high-riding vertebral artery, side-to-side asymmetry and irregular midline carotid artery loop was determined by subjective vision. 100 patients who underwent CTA for reasons other than CVJ deformity were enrolled as normal controls to evaluate the prevalence of vertebral artery anomaly in a normal population. Chi-square test was utilized for comparing the prevalence of vertebral artery anomaly between these two groups.
The incidence of PFIA was 25.6% (10/39), FEN was 7.7% (3/39), PICA was 5.1% (2/39), and the total incidence of extraosseous anomalous course of vertebral artery was 38.5% (15/39), significantly higher than that of control group, 7.0% (7/100) (P < 0.01). The incidence of high-riding vertebral artery and side-to-side asymmetry were 61.5% (24/39) and 30.8% (12/39), respectively. An irregular midline carotid artery loop was observed in five patients (12.8%).
Vertebral artery anomaly, which can be clearly depicted by CTA, is more frequent in BI patients. Preoperative CTA should be performed for this patient population to prevent vascular injury.
KeywordsVertebral artery Basilar invagination Craniovertebral junction Computed tomographic angiography
The authors would like to thank the staff members of the institutes.
Compliance with ethical standards
Conflict of interest
On behalf of all authors, the corresponding author states that there is no conflict of interest.
- 1.Chamberlain’s WE (1939) Basilar impression (platybasia): a bizarre developmental anomaly of the occipital bone and upper cervical spine with striking and misleading neurologic manifestations. Yale J Biol Med 11:487–496Google Scholar
- 7.Leconte P (1964) Fracture et luxation des deux premieres vertebres cervicales. In: Judet R (ed) Luxation Congenenitale de la Hanche. Fractures du Cou-de-pied Rachis Cervical. Actualites de Chirugie Orthopedique de Hopital Raymond-Poincare 3:147–166Google Scholar
- 20.Wright NM, Lauryssen C (2008) 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 1998 88:634–640Google Scholar
- 27.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 37:1389–1397CrossRefGoogle Scholar
- 37.Mandel IM, Kambach BJ, Petersilge CA (1998) Morphologic considerations of C2 isthmus dimensions for the placement of transarticular screws. Spine 2000 25:1542–1547Google Scholar