Congenital craniovertebral junction deformities can be associated with an anomalous vertebral artery (VA). At times, the artery crosses the joint posteriorly (i.e., persistent first intersegmental artery) and is at risk during posterior approach. We report a new variant, wherein the bilateral VA coursed medially after exiting the C3 transverse foramina to lie beneath C2 pars interarticularis and enter the foramen magnum (without passing through C2 transverse foramen anywhere along its course). This is possibly a result of bilateral persistent second intersegmental arteries. It is pertinent to recognize this unusual variant to avoid VA injury, especially while inserting C2 pars/transarticular screw.
Anomalous vertebral artery Persistent first intersegmental artery Posterior C2–3 fusion Pars interarticularis Congenital atlantoaxial dislocation
This is a preview of subscription content, log in to check access.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
Statement of informed consent
Informed consent was obtained from patient.
Bavinck JN, Weaver DD (1986) Subclavian artery supply disruption sequence: hypothesis of a vascular etiology for Poland, Klippel-Feil, and Möbius anomalies. Am J Med Genet 23:903–918CrossRefPubMedGoogle Scholar
Salunke P (2018) “Fusing the appropriate” in complex craniovertebral junction anomalies. Neurol India 66:151–152CrossRefPubMedGoogle Scholar
Salunke P, Futane S, Sahoo SK, Ghuman MS, Khandelwal N (2014) Operative nuances to safeguard anomalous vertebral artery without compromising the surgery for congenital atlantoaxial dislocation: untying a tough knot between vessel and bone. J Neurosurg Spine 20:5–10CrossRefPubMedGoogle Scholar
Salunke P, Sahoo S, Deepak AN (2015) Anomalous vertebral artery is not a deterrent to C1-2 joint dissection and manipulation for congenital atlantoaxial dislocation. Neurol India 63:1009–1012CrossRefPubMedGoogle Scholar
Salunke P, Sahoo S, Khandelwal NK, Ghuman MS (2015) Technique for direct posterior reduction in irreducible atlantoaxial dislocation: multi-planar realignment of C1-2. Clin Neurol Neurosurg 131:47–53CrossRefPubMedGoogle Scholar
Salunke P, Sahoo SK, Deepak AN, Ghuman MS, Khandelwal NK (2015) Comprehensive drilling of the C1-2 facets to achieve direct posterior reduction in irreducible atlantoaxial dislocation. J Neurosurg Spine 23:294–302CrossRefPubMedGoogle Scholar
Salunke P, Sahoo SK, Ghuman MS (2014) Bilateral inverted vertebral arteries (V3 segment) in a case of congenital atlantoaxial dislocation: distinct entity or a lateral variant of persistent first intersegmental artery? Surg Neurol Int 5:82CrossRefPubMedPubMedCentralGoogle Scholar
Salunke P, Sahoo SK, Sood S, Mukherjee KK, Gupta SK (2016) Focusing on the delayed complications of fusing occipital squama to cervical spine for stabilization of congenital atlantoaxial dislocation and basilar invagination. Clin Neurol Neurosurg 145:19–27CrossRefPubMedGoogle Scholar