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1.
World Neurosurg ; 154: e416-e420, 2021 10.
Artículo en Inglés | MEDLINE | ID: mdl-34293524

RESUMEN

OBJECTIVE: Retrotransverse foramen (RTF) and retrotransverse groove (RTG) are anatomic variations of the atlas (C1) vertebrae. RTF contains an anastomotic vein connecting atlanto-occipital and atlanto-axodian venous sinuses. The purpose of this study was to analyze the arterial vascular structures running though the RTF and RTG. METHODS: Three-dimensional volume rendered computed tomography angiography (3D VR CTA) images of 427 patients (264 men, 163 women; age 17-87 years) were reviewed and evaluated using the RadiAnt DICOM Viewer (version 5.0.2; Medixant, Poznan, Poland). The incidence of RTF or RTG, the incidence of the V3 segment of vertebral artery variants, and the artery vascular structures inside the RTF and RTG anatomic variation of C1 were analyzed. RESULTS: Fifty (11.7%) atlases presented RTF anatomical variant; 113 (26.5%) atlases presented RTG anatomical variants. The incidence of the V3 segment of vertebral artery variants was 0.94% (4 of 427). Three (0.7%) were persistent first intersegmental artery and 1 (0.2%) was the fenestration of the vertebral artery on left side. In 4 cases of C1 vertebral artery V3 segmental variants, there were no RTF and RTG. No artery vascular structure was found in RTF or RTG. CONCLUSIONS: The RTF or RTG of C1 was a common anatomical variant. No arterial vascular structure runs though the RTF or RTG. The presence of C1 RTF and RTG variants had no effect on the V3 segmental course of the vertebral artery. Preoperative understanding of these variations using 3D CTA are helpful for the safe execution of the upper cervical posterior approach surgeries.


Asunto(s)
Variación Anatómica , Atlas Cervical/anatomía & histología , Foramen Magno/anatomía & histología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Arterias/anomalías , Arterias/anatomía & histología , Atlas Cervical/anomalías , Atlas Cervical/irrigación sanguínea , Vértebras Cervicales/cirugía , Angiografía por Tomografía Computarizada , Femenino , Foramen Magno/anomalías , Foramen Magno/irrigación sanguínea , Humanos , Imagenología Tridimensional , Incidencia , Masculino , Persona de Mediana Edad , Arteria Vertebral/anomalías , Arteria Vertebral/anatomía & histología , Adulto Joven
2.
Surg Radiol Anat ; 42(9): 1127-1132, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-32488411

RESUMEN

PURPOSE: A skeleton named Iuzu has been unearthed from an exceptional middle Holocene burial in Toca dos Coqueiros site, in Serra da Capivara National Park (UNESCO World Heritage Site, Piauí State, Brazil). During a bioarchaeological analysis of its remains, we discovered that Iuzu was suffering from rare vertebral malformations. A double foramen transversaria, the agenesis of a foramen on the atlas and the hypoplasia of the transverse process of the axis have been highlighted. We aimed to deduce the clinical consequences of the malformation on the patient's health. METHODS: We proceeded to macroscopic observation and radiography of the bones, then we search for other examples of such a pathology in archaeological litterature. RESULT: The malformation caused vascular insufficiency that may have led to neurological lesions leading to various pains and troubles. The very rare malformations Iuzu presented have not been found on a paleoindian skeleton from South America so far. CONCLUSION: This case allowed us to examine the conditions of selection of individuals buried in southern Piauí during the Middle Holocene, during which time this rite does not seem to predominate.


Asunto(s)
Variación Anatómica , Vértebra Cervical Axis/anomalías , Atlas Cervical/anomalías , Anomalías Musculoesqueléticas/diagnóstico , Insuficiencia Vertebrobasilar/etiología , Vértebra Cervical Axis/irrigación sanguínea , Vértebra Cervical Axis/diagnóstico por imagen , Brasil , Atlas Cervical/irrigación sanguínea , Atlas Cervical/diagnóstico por imagen , Historia Antigua , Humanos , Anomalías Musculoesqueléticas/complicaciones , Anomalías Musculoesqueléticas/historia , Paleontología , Radiografía , Arteria Vertebral/anatomía & histología , Insuficiencia Vertebrobasilar/diagnóstico , Insuficiencia Vertebrobasilar/historia , Adulto Joven
3.
Surg Radiol Anat ; 41(9): 985-1001, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31172259

RESUMEN

BACKGROUND: The third part of the vertebral artery (VA) coursing in vertebral artery groove (VAG) may be injured during posterior craniocervical junction approaches. OBJECTIVE: The current study classifies all possible variants of the posterior arch (PA) of the atlas vertebra (C1), focusing on VAG and calculates their incidence. PA and VAG morphometry is studied in correlation with gender and age. Clinical and surgical implications of recorded variants are provided in an effort to explain associated pathology. The usefulness of three-dimensional computed tomography (3D-CT) in detecting PA variants is highlighted. MATERIALS AND METHODS: Two hundred and forty-four Greek adult dry C1 were classified in types according to PA morphology [i.e. presence of an imprint or a distinct VAG and occurrence of a partially or completely ossified dorsal (PDP or CDP) or lateral (PLP or CLP) ponticle unilaterally or bilaterally]. Combined variants were also included. RESULTS: A VAG and an imprint were detected in 42.62% and 15.16%. A PDP and CDP were observed in 18.03% and 15.98%, while a CLP and PLP in 2.05% and 1.64%, respectively. Combined PDP and PLP were detected in 2.05%, a CDP and CLP similarly to a CDP and PLP in 1.23% and a PDP and CLP in 0.40%. CONCLUSIONS: Variants' classification will contribute to an in depth understanding of the complex C1 anatomy and may explain cases of VA entrapment and injury during PA fixation. Surgeons should carefully study 3D-CT imaging to ensure type, location, size and shape of C1 ponticles in combination with VAG morphology and VA course before screw insertion.


Asunto(s)
Variación Anatómica , Atlas Cervical/irrigación sanguínea , Angiografía por Tomografía Computarizada/métodos , Imagenología Tridimensional , Arteria Vertebral/diagnóstico por imagen , Adulto , Tornillos Óseos/efectos adversos , Atlas Cervical/diagnóstico por imagen , Femenino , Humanos , Complicaciones Intraoperatorias/etiología , Complicaciones Intraoperatorias/prevención & control , Masculino , Persona de Mediana Edad , Fusión Vertebral/efectos adversos , Fusión Vertebral/instrumentación , Fusión Vertebral/métodos , Arteria Vertebral/lesiones , Insuficiencia Vertebrobasilar/etiología , Insuficiencia Vertebrobasilar/prevención & control , Adulto Joven
4.
World Neurosurg ; 123: 174-176, 2019 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-30557656

RESUMEN

BACKGROUND: The retrotransverse foramen (RTF) is a nonmetric variant of the atlas vertebra that consists of an abnormal accessory foramen located on the posterior root of the transverse process and it extends from the posterior root of the transverse process to the root of the posterior arch. Its presence has been related to regional variations of the venous circulation. It is currently unknown whether the RTF is a modern or an ancient anatomic variation. CASE DESCRIPTION: We analyzed the skeletal remains from the late-ancient Roman necropolis (II-VI centuries ad) of La Boatella (Valencia, Spain) and we found a well-preserved individual skeleton that presented with a left retrotransverse foramen in C1. CONCLUSIONS: The RTF is not a modern anatomic variation. As a result, ancient individuals had the same modifications in the regional circulation as modern subjects present today.


Asunto(s)
Variación Anatómica , Atlas Cervical/anatomía & histología , Adulto , Atlas Cervical/irrigación sanguínea , Femenino , Historia Antigua , Humanos , Persona de Mediana Edad , Mundo Romano
5.
Spine (Phila Pa 1976) ; 39(18): E1053-7, 2014 Aug 15.
Artículo en Inglés | MEDLINE | ID: mdl-24979141

RESUMEN

STUDY DESIGN: Retrospective review. OBJECTIVE: To evaluate the prevalence of anatomical variations of the vertebral artery at the craniovertebral junction and the posterior arch of the atlas in the US population. SUMMARY OF BACKGROUND DATA: Recent studies from Asia have reported a 5% to 10% prevalence of a persistent first intersegmental vertebral artery and 1% to 2% prevalence of a fenestrated artery. These anomalous vertebral artery courses lie directly over the starting point for atlas lateral mass screw insertion. The relatively high reported prevalence of these anomalies suggests that routine preoperative computed tomographic angiogram be considered prior to upper cervical fixation. We have not observed this anomaly as commonly as reported. METHODS: The authors analyzed the records of 975 patients from a level I trauma center and adjacent university hospital who underwent computed tomographic angiography to evaluate the incidence of anomalous variations in the third segment of the vertebral artery. These results were compared with similar studies performed in Korea and Japan. RESULTS: The mean age of the patients was 52.9 years. The ethnic distribution of the patients was as follows: 69.3% of the patients were Caucasian, 11% Asian, 10.8% African American, and 6% Hispanic. The prevalence of a persistent intersegmental artery was 0.01% (1/975); a fenestrated vertebral artery was 0.01% (1/975); and origin of a posterior inferior cerebellar artery was 0.4% (4/975). The incidence of these anomalies was significantly lower than those previously published from Korea and Japan. CONCLUSION: Vertebral artery course anomalies in the upper cervical spine were rare (0.42%) in our patient population. This finding contrasts with recent published reports from Asia, citing as high as a 10% rate of vertebral artery presence over the starting point for C1 lateral mass screw insertion. On the basis of the infrequent occurrence of this anomaly, we do not recommend routine computed tomographic angiography when planning upper cervical instrumentation. LEVEL OF EVIDENCE: N/A


Asunto(s)
Atlas Cervical/irrigación sanguínea , Cráneo/irrigación sanguínea , Malformaciones Vasculares/patología , Arteria Vertebral/anomalías , Angiografía , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Estudios Retrospectivos , Tomografía Computarizada por Rayos X , Estados Unidos/epidemiología , Malformaciones Vasculares/epidemiología , Arteria Vertebral/diagnóstico por imagen
6.
Eur J Orthop Surg Traumatol ; 23 Suppl 1: S101-5, 2013 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-23563588

RESUMEN

Several variations of the bony and vascular anatomy around the first and second cervical vertebrae have been reported. Failure to recognise these variations can complicate operations on the upper cervical spine. We present a patient with recent onset of cervical myelopathy due to stenosis at the C3-4 level. Preoperative evaluation identified Klippel-Feil syndrome with cervical fusion of C2-3, aplasia of posterior arch of C1, anomalous vertebral artery course and a "ponticulus posticus" of C2. The combination of these variations in a Klippel-Feil syndrome patient has never been reported. Thus, we recommend a thorough preoperative imaging evaluation, with CT scan and CT angiography or DSA, in addition to plain radiographs. This evaluation is imperative, before a cervical spine surgery, allowing a better understanding of the anatomy, in order to minimise the risks of misplacement of cervical instrumentation especially in such patients.


Asunto(s)
Atlas Cervical , Complicaciones Intraoperatorias/prevención & control , Síndrome de Klippel-Feil , Compresión de la Médula Espinal/cirugía , Fusión Vertebral/métodos , Arteria Vertebral , Anciano , Angiografía/métodos , Atlas Cervical/anomalías , Atlas Cervical/irrigación sanguínea , Atlas Cervical/diagnóstico por imagen , Atlas Cervical/cirugía , Femenino , Humanos , Síndrome de Klippel-Feil/diagnóstico , Síndrome de Klippel-Feil/fisiopatología , Síndrome de Klippel-Feil/cirugía , Imagen por Resonancia Magnética/métodos , Cuidados Preoperatorios/métodos , Ajuste de Riesgo , Compresión de la Médula Espinal/etiología , Compresión de la Médula Espinal/fisiopatología , Tomografía Computarizada por Rayos X/métodos , Arteria Vertebral/anomalías , Arteria Vertebral/diagnóstico por imagen , Arteria Vertebral/fisiopatología
7.
Folia Morphol (Warsz) ; 70(4): 287-90, 2011 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-22117247

RESUMEN

The current study evaluates the passage of the atlantal segment of the vertebral artery through the atlas to the cranial cavity in the case of occipitalisation, and searches for potential bony obstacles that constrict the lumen of the vertebral artery. Morphometric analysis was performed of the ossified atlanto-occipital articulation of the dry adult male skull, particularly in the region of the posterior arch of the atlas. The distance between the floor of the right groove for the vertebral artery and the occipital bone was measured using a digital sliding caliper. On the left side, measurements of the diameters of the inlet and outlet of the canal for the vertebral artery were performed using the same technique. Fusion of the left portion of the posterior arch of the atlas with the occipital bone caused significant narrowing of the space around the normally existing groove for the vertebral artery, and converted it into the canal. The size of the intracranial opening of the canal for the vertebral artery was measured as 3.8 mm x 4.7 mm, whereas the inlet to the canal was 5.4 mm x 7.0 mm. The diameter of the canal decreases, particularly at the entrance into the cranial cavity; therefore, compression of the vertebral artery within the canal seems to be possible.


Asunto(s)
Atlas Cervical/anomalías , Hueso Occipital/anomalías , Hueso Occipital/patología , Compresión de la Médula Espinal/patología , Arteria Vertebral/anomalías , Atlas Cervical/irrigación sanguínea , Humanos , Masculino , Persona de Mediana Edad , Arteria Vertebral/patología
8.
Spine (Phila Pa 1976) ; 36(2): 129-36, 2011 Jan 15.
Artículo en Inglés | MEDLINE | ID: mdl-20736892

RESUMEN

STUDY DESIGN: a series of 9 patients surgically treated with a novel combined pre-and retrovascular extraoral approach to lateral mass of the atlas (LMA) is examined. OBJECTIVE: to describe the efficacy of combined pre- and retrovascular extraoral approach in achieving a wide exposure and aggressive resection of tumors at the LMA. SUMMARY OF BACKGROUND DATA: the anatomic complexity and closeness to vital neurovascular structures raise technical difficulties in the surgical access to the LMA. Although various approaches, such as transoral approach, high anterior cervical approach, anterior lateral approach, and far lateral approach, have been reported in literature, wide exposure for the tumors at the LMA remains a unique challenge. METHODS: for our experience in the surgical exposure of the upper cervical spine, we have developed a combined pre- and retrovascular extraoral approach to the atlas since 2001. Nine patients with neoplastic lesions at the LMA were surgically treated through this combined approach. Reconstruction of stability was achieved by a posterior occipitocervical fusion through a posterior approach under the same anesthesia. RESULTS: this combined approach provided an excellent surgical field exposure to ensure the successful tumor resection while preventing the vertebral artery or nerve from injury. There was no operative mortality or severe morbidity in this series. Complications included 1 instance of transient dysphagia and 2 instances of transient trouble swallowing liquids. The symptoms of local pain and pharyngeal discomfort relieved, and patients suffering from spinal cord compression recovered well with 1 level of the Frankel scale when reevaluated 3 months after operation. With a follow-up period of 16 to 100 months, 1 patient with chondrosarcoma developed local recurrence at the 14th month of postoperation and died of respiratory and circulatory failure 39 months after surgery. No evidence of local recurrence was found in other patients. CONCLUSION: the combined pre- and retrovascular extraoral approach provides an advantageous alternative to previous reported approaches. For selected cases with tumor lesions at the LMA, this combined approach offers more benefits, through which a wide exposure with well-protected vertebral artery favoring radical excision could be achieved without complications normally associated with transoral surgery.


Asunto(s)
Atlas Cervical/cirugía , Vértebras Cervicales/cirugía , Procedimientos Ortopédicos/métodos , Neoplasias de la Columna Vertebral/cirugía , Adulto , Atlas Cervical/irrigación sanguínea , Atlas Cervical/patología , Vértebras Cervicales/irrigación sanguínea , Vértebras Cervicales/patología , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Neoplasias de la Columna Vertebral/irrigación sanguínea , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Adulto Joven
9.
Spine (Phila Pa 1976) ; 35(21): E1133-6, 2010 Oct 01.
Artículo en Inglés | MEDLINE | ID: mdl-20885280

RESUMEN

STUDY DESIGN: This is a technical note and review of the literature. OBJECTIVE: We propose to describe a revised surgical technique of C1 lateral mass screw insertion with protection of C1-C2 venous sinus surrounding the C2 nerve root. SUMMARY OF BACKGROUND DATA: During C1 lateral mass screw insertion and in posterior C1-C2 fixation, iatrogenic injury of C1-C2 venous sinus results in bleeding, which is troublesome. Appropriate management of the venous sinus in this region is critical to successful surgery in this complex anatomic region. METHODS: We reviewed 48 patients who underwent posterior C1-C2 fixation at our institution between September 2001 and October 2008. Twenty-four atlas screws were inserted by the originally described C1 lateral mass screw technique (group A), and 28 through a revised posterior arch and lateral mass screw technique (C1 transpedicular screw) (group B). The final group of 44 atlas screws was placed with our newly revised technique (group C). RESULTS: Bleeding of venous sinus was encountered in 3 group A, 2 group B, and 1 group C atlas screw insertions. The incidence rate was 12.50% (A), 7.14% (B), and 2.27% (C). Statistical comparison showed no significant difference between the groups. All the cases were followed for a mean period of 28.1 month. Four patients in group A complained of postoperative numbness in occipitocervical region. No patients in group B or group C voiced this complaint. A high fusion rate was found in all 3 groups with no signs of implant failure. CONCLUSION: Bleeding of C1-C2 venous sinus is vigorous and frustrating. The revised technique we describe provides theoretical and practical protection of venous sinus. In addition, the firm bony purchase of screws afforded by this technique contributes to achieving stabilization of the upper cervical spine and a high fusion rate.


Asunto(s)
Articulación Atlantoaxoidea/irrigación sanguínea , Articulación Atlantoaxoidea/cirugía , Tornillos Óseos/normas , Atlas Cervical/irrigación sanguínea , Atlas Cervical/cirugía , Fusión Vertebral/instrumentación , Fusión Vertebral/métodos , Adulto , Anciano , Articulación Atlantoaxoidea/patología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Venas/anatomía & histología , Venas/cirugía
11.
Int J Med Robot ; 4(2): 158-64, 2008 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-18481823

RESUMEN

BACKGROUND: One of the limiting factors of C1-C2 fixation is the location of the vertebral artery (VA). The authors sought to assess the potential variations in atlanto-axial VA anatomy using computed tomography angiography (CTA). METHODS: Detailed measurements were made on digital images of 106 patients undergoing CTA at our institution (54 males, 52 females; mean age 56, range 20-86). Distances, diameters and angles of osseous and vascular elements of the atlanto-axial complex were measured. RESULTS: Optimal C1 and C2 screw trajectories demonstrated wide variations among patients. The size of the VA groove or foramen was not predictive of exact arterial location or size. CONCLUSIONS: The size, location and path of the VA cannot be precisely predicted by the appearance of osseous structures such as the transverse foramina and/or the VA groove. CTA provides additional information regarding the atlanto-axial complex, and should be considered as a useful adjunct in the preoperative evaluation of select patients.


Asunto(s)
Vértebra Cervical Axis/irrigación sanguínea , Atlas Cervical/irrigación sanguínea , Arteria Vertebral/anatomía & histología , Adulto , Anciano , Anciano de 80 o más Años , Angiografía , Articulación Atlantoaxoidea/irrigación sanguínea , Articulación Atlantoaxoidea/diagnóstico por imagen , Vértebra Cervical Axis/diagnóstico por imagen , Tornillos Óseos , Atlas Cervical/diagnóstico por imagen , Femenino , Humanos , Fijadores Internos , Masculino , Persona de Mediana Edad , Modelos Anatómicos , Tomografía Computarizada por Rayos X
12.
J Neurosurg Spine ; 8(3): 230-6, 2008 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-18312074

RESUMEN

OBJECT: The current study evaluates the incidence of anatomical variations of the V(3) segment of the vertebral artery (VA) and the posterior arch of the atlas (C-1). Failure to appreciate these types of anatomical variations can cause catastrophic injury to the VA during posterior approaches to the upper cervical spine. METHODS: In the present study, the authors analyzed the records of 1013 Korean patients who underwent computed tomography (CT) angiography to evaluate the incidence of anomalous variations in the third segment of the VA and to determine the incidence and morphometric characteristics of any detected posterior ponticuli. The authors also hoped to determine any specific imaging features that might indicate a VA anomaly around the craniovertebral junction. RESULTS: The mean age of the patients was approximately 55.7 years and the prevalence of a posterior ponticulus was 15.6%. The incidence rate of a posterior ponticulus in the male population was 19.3%, whereas in the female population it was 12.8%. The incomplete type of posterior ponticulus was more common than the complete type. The mean age of the patients with an incomplete posterior ponticulus (55.7 years) was significantly younger (p = 0.018) than the mean age of patients with a complete posterior ponticulus (57.6 years). The incidence rate of a persistent first inter-segmental artery was 4.7% and the incidence rate of a fenestrated VA was 0.6%. The area of the C-1 transverse foramen on the abnormal side was significantly smaller than that of the contralateral normal side. CONCLUSIONS: The shape of the C-1 posterior arch and the third segment of the VA are heterogeneous. Therefore, preoperative radiological studies should be performed to identify any anatomical variations. Using preoperative 3D CT angiography, we can precisely identify an anomalous VA and significantly reduce the risk of VA injury.


Asunto(s)
Angiografía Cerebral , Atlas Cervical/anatomía & histología , Atlas Cervical/irrigación sanguínea , Imagenología Tridimensional , Laminectomía/métodos , Traumatismos Vertebrales/cirugía , Tomografía Computarizada por Rayos X , Arteria Vertebral/anatomía & histología , Articulación Atlantoaxoidea/diagnóstico por imagen , Articulación Atlantoaxoidea/lesiones , Articulación Atlantoaxoidea/cirugía , Tornillos Óseos , Atlas Cervical/diagnóstico por imagen , Femenino , Humanos , Fijadores Internos , Masculino , Persona de Mediana Edad
13.
Surg Radiol Anat ; 30(3): 239-42, 2008 May.
Artículo en Inglés | MEDLINE | ID: mdl-18253689

RESUMEN

BACKGROUND: The location of the vertebral artery on a groove on the superior surface of the posterior arch of atlas makes it vulnerable to injury during surgical procedures in this region. Knowledge of the quantitative anatomy of the vertebral artery groove is therefore necessary. METHODS: In 55 dry adult atlas vertebrae, the distance of the medial edges of the vertebral artery groove were measured from the posterior midline at both the inner and outer cortices of the posterior arch of atlas. In addition, the distance between the vertebral artery grooves on either side as well as the length of the vertebral artery groove was also measured. RESULTS: It was found that a minimum of 1.5 cm of the posterior arch could be safely exposed at both the outer and inner cortices. In addition, with mobilization of the vertebral artery from its groove on both the sides, an additional 1 cm of posterior arch could be exposed on either side. CONCLUSIONS: Exposure of the posterior arch of the atlas is an important step in surgical procedures for treatment of diverse conditions of the upper spinal cord and foramen magnum region. Injury to the vertebral artery in its position on the vertebral groove may lead to disastrous complications. The present study reveals that the neurosurgeon can safely expose up to 3.5 cm of the posterior arch of atlas and knowledge of this anatomic fact may help in planning surgical approaches.


Asunto(s)
Atlas Cervical/irrigación sanguínea , Columna Vertebral/irrigación sanguínea , Columna Vertebral/cirugía , Procedimientos Quirúrgicos Operativos , Arteria Vertebral/anatomía & histología , Adolescente , Adulto , Pesos y Medidas Corporales/métodos , Atlas Cervical/anatomía & histología , Humanos , Ilustración Médica , Persona de Mediana Edad , Columna Vertebral/anatomía & histología , Procedimientos Quirúrgicos Operativos/efectos adversos , Procedimientos Quirúrgicos Operativos/métodos
14.
Circ Cardiovasc Interv ; 1(2): 119-25, 2008 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-20031666

RESUMEN

BACKGROUND: Patients with chronic cervical internal carotid artery occlusion (ICAO) and cerebral ischemia may benefit from revascularization. The feasibility of endovascular recanalization for chronic ICAO has been reported recently, but its safety is still unproven. We report the follow-up results of 54 chronic ICAO patients who underwent endovascular recanalization, focusing on potential vascular complications and corresponding management. METHODS AND RESULTS: Endovascular recanalization for chronic ICAO was attempted in 54 consecutive patients (48 men; 69.2 + or - 9.8 years old) with either recurrent neurological deficit or objective ipsilateral hemisphere ischemia. Mean duration from occlusion documentation to the procedure was 237 + or - 327 days (range, 56 to 1424 days). Adverse events while in the hospital and during the 3-month follow-up were recorded. Successful recanalization was achieved in 35 of 54 patients (65%). Three-month cumulative stroke and death rate was 4% (2 of 54), including 1 in-hospital fatal nonipsilateral stroke and 1 in-hospital minor ipsilateral stroke secondary to systemic hypotension. Vascular complications developed in 3 of 54 patients (6%), including 1 late pseudoaneurysm formation 3 months after recanalization, 1 immediate carotid-cavernous fistula after recanalization, and 1 minor extravasation at carotid bifurcation after failed recanalization. However, no clinical sequela was noted with close follow-up and adequate management. CONCLUSIONS: Certain immediate or delayed vascular complications may develop during or after the endovascular recanalization for chronic ICAO. Although periprocedural death and stroke rate is limited in our study, further study combining neuroimaging tools and cognitive function evaluation is mandatory to assess its utility and appropriateness in patients with chronic ICAO.


Asunto(s)
Arteria Carótida Interna/cirugía , Estenosis Carotídea/terapia , Revascularización Cerebral , Anciano , Aneurisma Falso/etiología , Isquemia Encefálica/complicaciones , Isquemia Encefálica/terapia , Arteria Carótida Interna/patología , Estenosis Carotídea/complicaciones , Estenosis Carotídea/patología , Estenosis Carotídea/fisiopatología , Revascularización Cerebral/efectos adversos , Revascularización Cerebral/métodos , Revascularización Cerebral/mortalidad , Atlas Cervical/irrigación sanguínea , Estudios de Factibilidad , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Accidente Cerebrovascular/etiología , Tasa de Supervivencia , Resultado del Tratamiento
15.
AJNR Am J Neuroradiol ; 27(9): 1910-2, 2006 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-17032864

RESUMEN

Our aim was to describe the technique and clinical results of preoperative embolization of cervical spine osteoblastomas. We treated 3 patients with these tumors with transarterial embolization and subsequent surgical excision. In all 3 patients, distal access to the tumor-supplying vessels was gained with a microcatheter and embolization was performed with polyvinyl alcohol particles. No complications occurred. Surgical resection was performed in all patients without relevant bleeding. The postoperative course was uneventful in all patients. Preoperative embolization is a valuable adjunct to the surgical treatment of osteoblastomas of the cervical spine.


Asunto(s)
Vértebras Cervicales/irrigación sanguínea , Terapia Neoadyuvante , Osteoblastoma/irrigación sanguínea , Neoplasias de la Columna Vertebral/irrigación sanguínea , Adulto , Angiografía , Atlas Cervical/irrigación sanguínea , Atlas Cervical/diagnóstico por imagen , Atlas Cervical/cirugía , Vértebras Cervicales/diagnóstico por imagen , Vértebras Cervicales/cirugía , Terapia Combinada , Femenino , Hemostasis Quirúrgica , Humanos , Masculino , Persona de Mediana Edad , Osteoblastoma/diagnóstico por imagen , Osteoblastoma/cirugía , Neoplasias de la Columna Vertebral/diagnóstico por imagen , Neoplasias de la Columna Vertebral/cirugía , Tomografía Computarizada Espiral , Arteria Vertebral/diagnóstico por imagen
17.
AJNR Am J Neuroradiol ; 25(9): 1619-21, 2004 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-15502151

RESUMEN

During color Doppler examination of a 41-year-old man who presented with vertigo, a right vertebral artery could not be found. Both MR angiography and digital subtraction angiography revealed a large anastomotic vessel between the right internal carotid and vertebral artery. It was thought to be type I proatlantal artery. Furthermore, the external carotid arteries were bilaterally absent. Although each vascular anomaly mentioned above is rare, it even more rare for these variations to occur simultaneously.


Asunto(s)
Angiografía de Substracción Digital , Arteria Carótida Externa/anomalías , Malformaciones Vasculares del Sistema Nervioso Central/diagnóstico , Atlas Cervical/irrigación sanguínea , Procesamiento de Imagen Asistido por Computador , Imagenología Tridimensional , Angiografía por Resonancia Magnética , Ultrasonografía Doppler en Color , Arteria Vertebral/anomalías , Adulto , Aortografía , Arteria Carótida Externa/patología , Arteria Carótida Interna/anomalías , Arteria Carótida Interna/patología , Humanos , Masculino , Sensibilidad y Especificidad , Arteria Vertebral/patología
18.
AJNR Am J Neuroradiol ; 25(9): 1622-4, 2004 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-15502152

RESUMEN

Persistent proatlantal artery type 1 is one of the four anastomotic vessels between the carotid and vertebrobasilar arterial systems. Persistence of this embryonic anastomosis is extremely rare. We present such a case with bilateral persistent proatlantal arteries that arose from internal carotid arteries, entered the skull via the foramen magnum and united with the horizontal portions of vertebral arteries. We also mention its embryology, potential clinical implications, and differentiating features between two types of proatlantal arteries.


Asunto(s)
Angiografía de Substracción Digital , Aortografía , Arteria Carótida Interna/anomalías , Malformaciones Vasculares del Sistema Nervioso Central/diagnóstico , Infarto Cerebral/diagnóstico , Atlas Cervical/irrigación sanguínea , Angiografía por Resonancia Magnética , Arteria Vertebral/anomalías , Arteriosclerosis/complicaciones , Arteriosclerosis/diagnóstico , Arteria Carótida Interna/patología , Infarto Cerebral/etiología , Foramen Magno/patología , Humanos , Embolia Intracraneal/complicaciones , Embolia Intracraneal/diagnóstico , Masculino , Persona de Mediana Edad , Arteria Vertebral/patología
19.
Anat Sci Int ; 79(3): 167-71, 2004 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-15453618

RESUMEN

The atlas of a 52-year-old male Japanese cadaver, which had been removed and macerated, presented a bilateral unknown bone bridge forming a foramen (Case 1). The bone bridge connected the ponticulus lateralis (PL) and posterior (PP) to form an oval foramen between the superior roots of both ponticuli. The atlas of a 69-year-old male Japanese cadaver was found to have similar variations in situ (Case 2). In this case, the right bone bridge connected the superior root of the incomplete PL and the inferior root of the also incomplete PP to form a long ellipsoid foramen opening medially. The medial opening of the foramen was closed by a ligamentous connective tissue in situ. The condylar emissary vein passed this complete foramen to join the cervical epidural venous plexus. The similar bilateral foramen in case 1 was supposed to pass the same vein as in case 2. The bone bridge between the two ponticuli and the resulting foramen mentioned above have not been described previously, as far as we know. We propose that these structures be called the ponticulus interponticularis atlantis and the foramen atlantoideum interponticulare, respectively.


Asunto(s)
Atlas Cervical/anomalías , Anomalías Congénitas , Anciano , Cadáver , Calcinosis , Atlas Cervical/irrigación sanguínea , Atlas Cervical/fisiología , Duramadre/irrigación sanguínea , Humanos , Ligamentos/anomalías , Masculino , Persona de Mediana Edad , Venas/anomalías , Arteria Vertebral/anatomía & histología
20.
J Neuroradiol ; 31(5): 391-6, 2004 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-15687958

RESUMEN

The persistent carotid-vertebrobasilar anastomoses (PCVBA) can be explained by an interruption of the vertebrobasilar system (VBS) embryogenesis. We present two very rare cases of persistent anastomoses: a hypoglossal artery and a type I proatlantal artery, insisting on the angiographic criteria allowing differentiation. After a brief review of the embryogenesis of the VBS, we describe the different types of persistent anastomoses (hypoglossal, type I and II proatlantal, trigeminal and otic arteries). We will insist on the potential risks, not well-known, but typical of each anastomosis. PCVBA usually are incidental findings but imaging follow-up may be required since aneurysms may develop.


Asunto(s)
Aneurisma Roto/embriología , Arterias Carótidas/anomalías , Atlas Cervical/irrigación sanguínea , Nervio Hipogloso/irrigación sanguínea , Aneurisma Intracraneal/embriología , Malformaciones Arteriovenosas Intracraneales/embriología , Arteria Vertebral/anomalías , Aneurisma Roto/diagnóstico por imagen , Arterias Carótidas/diagnóstico por imagen , Arterias Carótidas/embriología , Cerebelo/irrigación sanguínea , Cerebelo/diagnóstico por imagen , Cerebelo/embriología , Diagnóstico Diferencial , Humanos , Nervio Hipogloso/diagnóstico por imagen , Nervio Hipogloso/embriología , Malformaciones Arteriovenosas Intracraneales/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Radiografía , Nervio Trigémino/irrigación sanguínea , Nervio Trigémino/diagnóstico por imagen , Nervio Trigémino/embriología , Arteria Vertebral/diagnóstico por imagen , Arteria Vertebral/embriología
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