Dynamic compression in vertebral artery dissection in children: apropos of a new protocol

Abstract

Purpose

Our goals are (1) to report a consecutive prospective series of children who had posterior circulation stroke caused by vertebral artery dissection at the V3 segment; (2) to describe a configuration of the vertebral artery that may predispose to rotational compression; and (3) to recommend a new protocol for evaluation and treatment of vertebral artery dissection at V3.

Methods

All children diagnosed with vertebral artery dissection at the V3 segment from September 2014 to July 2020 at our institution were included in the study. Demographic, clinical, surgical, and radiological data were collected.

Results

Sixteen children were found to have dissection at a specific segment of the vertebral artery. Fourteen patients were male. Eleven were found to have compression on rotation during a provocative angiogram. All eleven underwent C1C2 posterior fusion as part of their treatment. Their mean age was 6.44 years (range 18 months–15 years). Mean blood loss was 57.7 mL. One minor complication occurred: a superficial wound infection treated with oral antibiotics only. There were no vascular or neurologic injuries. There have been no recurrent ischemic events after diagnosis and/or treatment. Mean follow-up was 33.3 months (range 2–59 months). We designed a new protocol to manage V3 dissections in children.

Conclusion

Posterior C1C2 fusion is a safe and effective option for treatment of dynamic compression in vertebral artery dissection in children. Institution of and compliance with a strict diagnostic and treatment protocol for V3 segment dissections seem to prevent recurrent stroke.

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Data Availability

Pertinent data is shown in Table 1; full data is available upon request.

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Acknowledgments

We would like to thank Ms. Suzanne Truex, medical illustrator, for the drawings and figures, and Ms. Rayna Ross, program coordinator, for the tables and paper formatting.

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Authors

Contributions

Bruno P. Braga: Conceptualization, design, methodology, investigation, writing-original draft, writing-review and editing, and supervision

Rafael Sillero: Conceptualization, design, methodology, and writing-review and editing,

Rosalina M. Pereira: Conceptualization, methodology, investigation, and writing-review and editing

Kamran Urgun: Conceptualization, methodology, and writing-review and editing

Dale M. Swift: Conceptualization, methodology, and writing-review and editing

Nancy K. Rollins: Conceptualization, methodology, and writing-review and editing

Amy J. Hogge: Conceptualization, methodology, and writing-review and editing

Michael M. Dowling: Conceptualization, design, methodology, investigation, and writing-review and editing

Corresponding author

Correspondence to Bruno P. Braga.

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We have no conflicts of interest to report.

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The study was conducted in compliance with HIPAA and approved by the institutional review board.

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A portion of this study was presented as an oral presentation at 2019 AANS Annual Scientific Meeting in San Diego, CA, USA, April 2019.

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Braga, B.P., Sillero, R., Pereira, R.M. et al. Dynamic compression in vertebral artery dissection in children: apropos of a new protocol. Childs Nerv Syst (2020). https://doi.org/10.1007/s00381-020-04956-1

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Keywords

  • Bow hunter syndrome
  • Vertebral artery dissection
  • C1C2 fusion
  • Dynamic arterial compression
  • Posterior circulation stroke