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A comprehensive analysis and literature review of vertebral artery variation in craniovertebral junction using three-dimensional computed tomography angiography

  • Spinal Neuroradiology
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Abstract

Purpose

To describe vertebral artery (VA) variation in patients with or without osseous anomalies at congenital craniovertebral junction (CVJ).

Methods

In the present study, we retrospectively analyzed 258 patients with VA variation who underwent three-dimensional computed tomography angiography (3D CTA) in our hospital from March 2017 to October 2019.

Results

Among 258 patients, 180 were accompanied by skeleton structural malformation, including 105 cases of occipital ossification of the atlas, 8 cases of the bipartite atlas, 7 cases of hypoplasia of the posterior arch of the atlas, 45 cases of C2/3 congenital fusion, 2 cases of C2/3/4 congenital fusion, and 13 cases of congenital os odontoid. VA variation was divided into type A (VA variation in the CVJ area without osseous anomalies) and type B (VA variation in the CVJ area with osseous anomalies). There are totally 10 subtypes, including type A1 (atlas occipitalization with VA entrance approach close to middle line, 20.2%); type A2 (atlas occipitalization with VA entrance approach far from middle line, 30.2%); type A3 (first intersegmental VA in C1–C2, 1.9%); type A4 (fenestration of the VA, 2.3%); type A5 (VA bulging type, 6.6%); type A6 (VA exposures with the absence of the posterior atlas arch, 2.3%); type A7 (C2 inner wall type, 0.4%); type A8 (single vertebral artery, 2.3%); type B1 (posterior ponticuli, 2.7%); and type B2 (high-riding VA, 31.4%).

Conclusion

This study is expected to take the lead in the most comprehensive classification of VA variation.

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Author notes

  1. Guo-Qiang Liu and Hao-Zhi Yang contributed equally to this work.

Authors and Affiliations

  1. Department of Orthopedics, General Hospital of Southern Theatre Command of PLA, 111 Liuhua Road, Guangzhou, 510010, People’s Republic of China

    Hao-Zhi Yang, Guo-Qiang Liu, Hong Xia, Xiang-Yang Ma & Jian-Hua Wang

  2. Guangzhou University of Chinese Medicine, Guangzhou, 510405, People’s Republic of China

    Guo-Qiang Liu

  3. Southern Medical University, No.1838 North of Guangzhou Road, Guangzhou, 510515, People’s Republic of China

    Jian-Hua Wang

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  1. Hao-Zhi Yang
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Correspondence to Jian-Hua Wang.

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The authors declare no competing interests.

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This retrospective study was approved by the institutional ethical committee of General Hospital of Southern Theatre Command of PLA. All participants were informed about the study and provided written informed consent about access to imaging data.

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Yang, HZ., Liu, GQ., Xia, H. et al. A comprehensive analysis and literature review of vertebral artery variation in craniovertebral junction using three-dimensional computed tomography angiography. Neuroradiology 65, 215–223 (2023). https://doi.org/10.1007/s00234-022-03082-w

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