Cirugía de la patología de la arteria vertebral. Revisión / Surgery of the pathology of the vertebral artery. Revision

Se realiza una revisión sobre la patología de la arteria vertebral, valorando las repercusiones que su oclusión parcial o total desarrolla. Se analiza la clínica que ocasiona este tipo de patología a la vez que se valoran los medios diagnósticos para la detección dela lesión oclusiva. Se discuten las diferentes estrategias y procedimientos terapéuticos en los pacientes portadores de esta patología y se valoran los diferentes datos aportados en la bibliografía y que corresponden a los estudios más importantes que se han realizado. Este tipo de afección se muestra como una patología con dificultades para su detección y con unas indicaciones terapéuticas quirúrgicas muy discutibles cuando se aplican con una no muy clara evidencia científica de la pertinencia de su realización. (AU)

A review is carried out on the pathology of the vertebral artery, assessing the repercussions that its partial or total occlusion develops. The symptoms that cause this type of pathology are analyzed at the same time as the diagnostic means for detecting theocclusive lesion are evaluated. The different strategies and therapeutic procedures in patients with this pathology are discussed andthe different data provided in the bibliography and corresponding to the most important studies that have been carried out are valued. This type of condition is shown as a pathology with difficulties in its detection and with highly debatable surgical therapeuticindications when applied with not very clear scientific evidence of the relevance of its performance. (AU)

A left vertebral artery arising from the aortic arch: a cadaveric study

Variations in the major arteries and their branches of the thoracic region have been well described with variations of the aortic arch, pulmonary trunk, common carotid arteries and vertebral arteries being among the most common in the thoracic region. During routine dissection of the thoracic and neck regions, the left vertebral artery in a 58-year-old female cadaver was found to arise from the arch of the aorta between the left common carotid and the left subclavian arteries. The left vertebral artery was traced along its course and was observed to enter the transverse foramen of the fifth cervical vertebral body. With such variation, the findings can influence predisposition to diseases, symptomatology, clinical examination, investigation and patient management, including operative surgery

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Variations in the branching pattern of the aortic arch: an African perspective

Variation in the branches of the aortic arch is higher in individuals of African descent. However, published studies are few. The aims were to document variations in the branching pattern of the aortic arch in a South African sample, determine whether these variants are more common than other populations, and determine whether there are any significant differences in the prevalence of variation between males and females. The aortic arch and main branches were dissected in 733 cadavers. All branching patterns were documented and classified as types. Chi-Square tests were used to determine whether there were any significant differences in prevalence of variation between males and females. The diameters of the main branches were measured and compared between sexes.The standard branching pattern was present in 65% of individuals, similar to that reported for other African studies, but lower than other studies from around the world. Variations were more prevalent in males than in females (p = 0.025), while only the diameter of the left vertebral artery, when arising from the arch was significantly larger in females, with no differences between sexes for the other vessel diameters. The results of this study support the hypothesis that variations in the branching pattern of the aortic arch are more common in African individuals. These individuals may be at increased risk of associated although rare, clinical symptoms or iatrogenic injury

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Anatomical variations of the vertebral artery and its relation to the atlas vertebra - Radiological and dry bone study

Vertebral artery (VA) variations are important for diagnostic angiographic procedures. This study aimed to describe the anatomical variations of VA using multidetector computed tomography angiography (MDCTA), and to provide a quantitative and qualitative anatomy of the VA groove in dry atlas vertebrae. The study was carried out on 100 MDCTA images from adult Egyptian individuals (69 males; 31 females) and 50 dry atlas fully ossified and of unknown age and sex. MDCTA films were evaluated for VA origin, level of entrance into foramen transversarium, caliber, and distance from the midline. VA grooves in dry bones were examined for the presence of ponticulus posticus (PP). Inner and outer distances from the midline, width and thickness were measured using sliding Vernier caliper. The results revealed that the left VA arose directly from the aortic arch in 7% of cases and was absent in 2% of cases. Atypical entry of VA into foramen transversarium was through C5 (4.5%), followed by C7 (1.5%), then C4 (1%). The left vertebral arteries with direct aortic origin were more medially located than the left arteries with subclavian origin (p=0.005). The mean diameter was significantly greater on the left (3.67±1.07 mm), as compared to the right side (3.36±0.93 mm) (p=0.038). PP was detected in 47% of cases in radiological images and 96% of dry bones. It could be concluded that the most important variations of VA were the aortic origin of the left VA and abnormal entry through transverse foramina. PP was a common variation in atlas vertebrae. These variations should be taken into consideration during radiological and orthopedic procedures

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Fístula arteriovenosa traumática de la arteria vertebral / Traumatic arteriovenous fistula of the vertebral artery

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A rare case of the dual origin of the right vertebral artery with an aortic arch origin of the left vertebral artery

In clinical practice, rare structural vascular variations pose important risks for clinical procedures such as diagnostic vascular interventions or surgical treatment. The authors herein describe a rare case of an unusual origin of both vertebral arteries in a singular adult male cadaver. The two right vertebral arteries independently originated from the right subclavian artery, while the left vertebral artery took origin from the aortic arch. The left vertebral artery entered the 5th transverse foramen while the two right vertebral arteries entered the 4th and 6th transverse foramen, respectively

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SAPIEN 3 embolizada por fuga en el conector en Y / SAPIEN 3 embolization due to a leak in the y connector

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Description of 'Ponticular Artery' at the atlas: an anatomical case report with potential clinical relevance

The atlas plays an important role as a characteristic connective bony element between the cervical spine and the occiput. Its details and variations are of special interest to neurosurgeons - e.g., in a far lateral transcondylar approach. We investigated 121 atlases and their variations. During our investigations, we periodically found atlases with a complete arcuate foramen (canal for vertebral artery) and an additional foramen in the bony roof of a complete arcuate foramen. Different structures passing through this additional foramen are described in the literature, but no artery. We found a macroscopically clear verified artery in a 67-year-old male cadaver passing through the foramen in the bony roof of a complete arcuate foramen. Such an artery is of clinical importance to neurosurgeons or musculoskeletal surgeons, but unmentioned in literature until now. A potential name for this artery could be 'ponticular artery'. The discovered artery is most likely a branch to the neck muscles. The knowledge of a possible existence of such an artery is necessary to prevent complications during surgical procedures in the region of the upper cervical spine. Furthermore, the special course of this artery could be the reason for atrophy and imbalance of deep cervical muscles and consequently headaches

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Fístulas arteriovenosas de los troncos supraaórticos / Arteriovenous fistulas of supra-aortic trunks

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Disección de arteria vertebral e infarto cerebeloso como complicación tardía de manipulación cervical: a propósito de un caso / Vertebral artery dissection and cerebellar infarction as a late complication of cervical spine manipulation: a case report

La manipulación cervical es una técnica ampliamente empleada en el tratamiento de dolores cervicales y algunos tipos de cefalea. Es fácil de realizar y generalmente inocua, pero en ocasiones puede producir complicaciones vasculares. Son múltiples los profesionales que la emplean. Presentamos el caso de un paciente que sufre una disección de arteria vertebral e infarto cerebeloso como complicación tardía de una manipulación cervical. Proponemos que en los pacientes con clínica de dolor cervical, cefalea o afectación del territorio vascular posterior a una manipulación cervical estos síntomas sean tenidos en cuenta como posible complicación de la misma (AU)

Cervical manipulation is a widely used technique in the treatment of cervical pain and some types of headache. It is easy to perform and is usually harmless but can occasionally cause vascular complications. The technique is used by multiple professionals. We report the case of a patient with a vertebral artery dissection and cerebellar infarction as a late complication of cervical manipulation. We suggest that symptoms of neck pain, headache or disturbances of the posterior circulation after cervical manipulation should be considered possible complications of the technique (AU)

Disección de la arteria vertebral asociada a síndrome MURCS / Vertebral artery dissection associated with MURCS syndrome

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Arterias subclavia y vertebrales aberrantes en síndrome aórtico agudo / Aberrant subclavian and vertebrals arteries in acute aortic syndrome

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Reparación de punción iatrogénica de arteria subclavia izquierda con cierre percutáneo / Repair of iatrogenic puncture of left subclavian artery with percutaneous closu

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Radiculopatía compresiva C5-C6 secundaria a disección espontánea de la arteria vertebral derecha / Compressive C5-C6 radiculopathy secondary to spontaneous vertebral artery dissection

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Tic convulsivo doloroso como manifestación de dolicoestasia y aneurisma vertebrobasilar / Painful tic convulsif as manifestation of vertebrobasilar dolichoectasia and aneurysm

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Limitaciones del Doppler transcraneal en el diagnóstico de la muerte encefálica / Limitations of transcranial Doppler in the diagnosis of brain death

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Anatomical variations of the pre-transverse segment of the vertebral artery in Indian cadavers

Variations of the first segment (V1) of the vertebral arteey (VA) are important to spine surgeons and radiologists. The present study was conducted to document the anatomical variations of the V1 segment and estimate side and gender differences, if any. The study was a cross-sectional analytical study performed on 33 adult cadavers (24 male and 9 female) of Indian origin. The V1 segment of 67 VA was dissected and the following parameters were noted: site of origin, level of entry into cervical spine, presence of tortuosity, length, external diameter and presence of hypoplasia. Side differences were estimated using the paired sample T test and Wilcoxon signed rank test. The independent sample T test and Chi square test were used to estimate gender differences. An unusual origin of the right VA from the thyrocervical trunk, in addition to the origin of the left VA from the arch of the aorta, was noted. Stenotic segments were observed in 4.5% of the VA. Rare levels of entry into the cervical column of the V1 segment of the VA included the foramen transversarium of C5 (4.5%) and C7 vertebra (2.5%). Nine per cent of V1 segments showed a high degree of tortuosity. The mean length and diameter of the V1 segments were 3.7±1.5 cm and 4.2±0.9 mm respectively. Hypoplasia was observed in 18% of the V1 segments. The mean length of the V1 was found to be significantly greater on the left side. Male cadavers had a significantly greater external diameter of V1. The knowledge of these variations of the V1 segment of the VA is imperative for the safe performance of anterior spine procedures

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Function and surgery of the carotid and vertebral arteries

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Vertebro-Basilar occlusive disease

Vertebro-basilar occlusive disease is a condition that can cause symptomatology related to encephalic posterior circulation ischemia. Vertebro-basilar (VB) ischemia represents a 25% of all TIA’s and Strokes in North America (1). In a patient with a VB-TIA, if vertebro-basilar (VB) pathology is demonstrated, he or she will have a 30-35% risk of having a VB circulation stroke in the next 5 years (2); demonstrating that vertebro-basilar occlusive disease is a relevant condition regarding mortality, morbidity and health-related costs. Since Crawford and colleagues described the trans-subclavian vertebral artery endarterectomy by the end of the 50’s, vertebro- basilar occlusive disease has been studied rather little. We pretend to do a revision of this disease, and to discuss briefly the most up-to-date therapies described in current literature for this condition (AU)

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Near complete tracheal rings in an adult male cadaver associated with variation in V2 and V3 segments of vertebral artery

During routine dissection in an adult male cadaver, the presence of long segment near complete tracheal rings associated with variation in the second (V2) of right vertebral artery (VA) and third (V3) segments of the left VA was encountered. This case report highlights the normal lifespan of an individual despite anatomical variations that are reported to be incompatible with life. Congenital complete and near-complete tracheal rings are extremely rare tracheal deformities, and long-segment occurrences of these variations are usually incompatible with life. They are reported to be associated with cervical chondrogenic anomalies and craniosynostotic syndromes.In the same cadaver the left VA entered the foramen transversarium (FT) of C6 vertebra and exited through the FT of the axis. It formed a loop below the arch of atlas and entered the vertebral canal between the atlas and axis, completely bypassing the FT of the atlas. A branch from the loop divided into two branches, one of which supplied the dorsal ramus of C1, the other ending in the surrounding neck musculature. The right VA was normal, except that it entered the FT of C5 vertebra bypassing C6 vertebra. It was noted that the calibre of the VA on the left side was considerably more than that on the right. Variations in the vertebrobasilar system have a potential clinical impact, since they are the feed arteries of the brain (AU)

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