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Compression Syndromes of the Vertebral Artery at the Craniocervical Junction

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New Trends in Craniovertebral Junction Surgery

Part of the book series: Acta Neurochirurgica Supplement ((NEUROCHIRURGICA,volume 125))

Abstract

Compression syndromes of the vertebral artery that occur at the craniocervical junction are extremely rare causes of haemodynamic insufficiency of the posterior cerebral circulation. The aetiology of the compression syndrome may be a malformation, trauma, tumour, infection or degenerative pathology. This may lead to dynamic vertebral artery occlusion where the vessel courses around the atlas and the axis—the so-called V3 segment. This in turn may result in insufficient collateral flow to the posterior fossa. The clinical picture is a vertebrobasilar insufficiency syndrome of variable expression ranging from vertigo to posterior fossa stroke. The typical clinical presentation is syncope occurring during rotation of the head, also known as ‘bow hunter’s syndrome’. The workup is based on dynamic angiography and computed tomography angiography. The treatment of choice is surgical vascular decompression, resulting in a good clinical outcome. However, in some instances, atlantoaxial fusion may be indicated. Alternatively, conservative and endovascular options have to be considered in inoperable patients.

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Author information

Authors and Affiliations

  1. Neurochirurgische Klinik, Universitätsklinikum, Dusseldorf, Germany

    Jan Frederick Cornelius

  2. Service de neuroradiologie interventionnelle, CHU, Strasbourg, France

    Raoul Pop

  3. Neurosurgery Department, Cannizzaro Hospital, Catania, Italy

    Marco Fricia

  4. Service de neurochirurgie, CHU Lariboisiere, Paris, France

    Bernard George

  5. Service de neurochirurgie, CHU, Strasbourg, France

    Salvatore Chibbaro

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  1. Jan Frederick Cornelius
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  2. Raoul Pop
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  3. Marco Fricia
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  4. Bernard George
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  5. Salvatore Chibbaro
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Correspondence to Jan Frederick Cornelius .

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Editors and Affiliations

  1. Institute of Neurosurgery, Catholic University of Rome, Institute of Neurosurgery, Rome, Italy

    Massimiliano Visocchi

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Cornelius, J.F., Pop, R., Fricia, M., George, B., Chibbaro, S. (2019). Compression Syndromes of the Vertebral Artery at the Craniocervical Junction. In: Visocchi, M. (eds) New Trends in Craniovertebral Junction Surgery. Acta Neurochirurgica Supplement, vol 125. Springer, Cham. https://doi.org/10.1007/978-3-319-62515-7_22

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  • DOI: https://doi.org/10.1007/978-3-319-62515-7_22

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