Abstract
Symptomatic extracranial vertebral artery (VA) dissection may need surgery. We describe such a case successfully treated with atlantoaxial fusion based on its rare dynamic angiographic findings. A 27-year-old woman suffered from repeated brainstem and cerebellar infarctions from a left extracranial VA dissecting aneurysm. Dynamic angiography showed the dissecting aneurysm of the V3 segment in the neutral head position, and deflation of the aneurysm during rightward head rotation. She underwent posterior atlantoaxial fusion, and the lesion was repaired with no subsequent ischemia. Posterior atlantoaxial fusion can be an option for some extracranial VA dissections with preserving its anterograde blood flow.
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Ansari SA, Thompson BG, Gemmete JJ, Gandhi D (2008) Endovascular treatment of distal cervical and intracranial dissections with the Neuroform stent. Neurosurgery 62:636–46, discussion 636-462
Barr JD, Lemley TJ (1999) Endovascular arterial occlusion accomplished using microcoils deployed with and without proximal flow arrest: results in 19 patients. Am J Neuroradiol 20:1452–1456
Berguer R, Flynn LM, Kline RA, Caplan L (2000) Surgical reconstruction of the extracranial vertebral artery: management and outcome. J Vasc Surg 31:9–18
Blickenstaff KL, Weaver FA, Yellin AE, Stain SC, Finck E (1989) Trends in the management of traumatic vertebral artery injuries. Am J Surg 158:101–5, discussion 105-6
Caplan LR (2008) Dissections of brain-supplying arteries. Nat Clin Pract Neurol 4:34–42
Chiche L, Praquin B, Koskas F, Kieffer E (2005) Spontaneous dissection of the extracranial vertebral artery: indications and long-term outcome of surgical treatment. Ann Vasc Surg 19:5–10
Choi KD, Choi JH, Kim JS, Kim HJ, Kim MJ, Lee TH, Lee H, Moon IS, Oh HJ, Kim JI (2013) Rotational vertebral artery occlusion: mechanisms and long-term outcome. Stroke 44:1817–24
Cohen JE, Gomori JM, Umansky F (2003) Endovascular management of spontaneous bilateral symptomatic vertebral artery dissections. AJNR Am J Neuroradiol 24:2052–6
Fiorella D, Albuquerque FC, Deshmukh VR, McDougall CG (2005) Usefulness of the Neuroform stent for the treatment of cerebral aneurysms: results at initial (3-6-mo) follow-up. Neurosurgery 56:1191–201, discussion 1201-2
Harms J, Melcher RP (2001) Posterior C1-C2 fusion with polyaxial screw and rod fixation. Spine 26:2467–2471
Jost GF, Dailey AT (2015) Bow hunter’s syndrome revisited: 2 new cases and literature review of 124 cases. Neurosurg Focus 38, E7
Kernan WN, Ovbiagele B, Black HR, Bravata DM, Chimowitz MI, Ezekowitz MD, Fang MC, Fisher M, Furie KL, Heck DV, Johnston SC, Kasner SE, Kittner SJ, Mitchell PH, Rich MW, Richardson D, Schwamm LH, Wilson JA, American Heart Association Stroke Council, Council on Cardiovascular and Stroke Nursing, Council on Clinical Cardiology, Council on Peripheral Vascular Disease (2014) Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 45:2160–236
Kieffer E, Praquin B, Chiche L, Koskas F, Bahnini A (2002) Distal vertebral artery reconstruction: long-term outcome. J Vasc Surg 36:549–54
Lylyk P, Cohen JE, Ceratto R, Ferrario A, Miranda C (2001) Combined endovascular treatment of dissecting vertebral artery aneurysms by using stents and coils. J Neurosurg 94:427–32
Mokri B, Houser OW, Sandok BA, Piepgras DG (1988) Spontaneous dissections of the vertebral arteries. Neurology 38:880–5
Morasch MD, Phade SV, Naughton P, Garcia-Toca M, Escobar G, Berguer R (2013) Primary extracranial vertebral artery aneurysms. Ann Vasc Surg 27:418–423
Morgan MK, Sekhon LH (1994) Extracranial-intracranial saphenous vein bypass for carotid or vertebral artery dissections: a report of six cases. J Neurosurg 80:237–46
Panjabi M, Dvorak J, Duranceau J, Yamamoto I, Gerber M, Rauschning W, Bueff HU (1988) Three-dimensional movements of the upper cervical spine. Spine (Phila Pa 1976) 13:726–30
Pham MH, Rahme RJ, Arnaout O, Hurley MC, Bernstein RA, Batjer HH, Bendok BR (2011) Endovascular stenting of extracranial carotid and vertebral artery dissections: a systematic review of the literature. Neurosurgery 68:856–66, discussion 866
Schievink WI (2001) Spontaneous dissection of the carotid and vertebral arteries. N Engl J Med 344:898–906
Schievink WI, Mokri B, O’Fallon WM (1994) Recurrent spontaneous cervical-artery dissection. N Engl J Med 330:393–397
Sturzenegger M, Mattle HP, Rivoir A, Rihs F, Schmid C (1993) Ultrasound findings in spontaneous extracranial vertebral artery dissection. Stroke 24:1910–21
Takeshima Y, Nishimura F, Park YS, Nakase H (2014) Fusion surgery for recurrent cerebellar infarctions due to bilateral atlantoaxial rotational vertebral artery occlusion. Spine (Phila Pa 1976) 39:E860–3
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Ikeda, N., Hayashi, H., Goto, M. et al. Posterior atlantoaxial fusion as treatment option for extracranial vertebral artery dissecting aneurysm: a case report and literature review. Acta Neurochir 158, 1741–1744 (2016). https://doi.org/10.1007/s00701-016-2891-4
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DOI: https://doi.org/10.1007/s00701-016-2891-4