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Vertebral artery injury

Fabio Ramponi, Michael Seco, James B Edelman, Andrew G Sherrah, Paul G Bannon, R John L Brereton, Michael K Wilson, Michael P Vallely
Coronary surgery performed on an arrested heart, using one internal mammary artery and a saphenous vein carries two main potential drawbacks: the known failure rate of vein grafts and the relatively high rate of neurologic injury. To address these concerns, we describe a technique that achieves complete revascularization without manipulating the ascending aorta (anaortic, off-pump) and utilizing total arterial grafts. All patients undergo thorough preoperative investigation, including bilateral carotid, vertebral and subclavian artery Duplex ultrasounds...
July 2018: Annals of Cardiothoracic Surgery
Jed T Ritter, Chadd K Kraus
Blunt traumatic cervical vascular injury (BCVI) is challenging to recognize, but it is a potentially devastating entity that warrants attention from emergency physicians. Injury to the vertebral or carotid artery can result in a delayed manifestation of neurologic injury that may be preventable if promptly recognized and treated. The modified Denver Criteria are frequently used to guide imaging decisions for BCVI; however, injuries can still be missed. We present a case of BCVI in a trauma patient whose initial presentation evaded standard screening criteria, illustrating the need for a high index of suspicion for BCVI in blunt trauma...
August 2018: Clinical practice and cases in emergency medicine
Joshua D Burks, Andrew K Conner, Robert G Briggs, Phillip A Bonney, Adam D Smitherman, Cordell M Baker, Chad A Glenn, Cameron A Ghafil, Dillon P Pryor, Kyle P O'Connor, Bradley N Bohnstedt
OBJECTIVE A shifting emphasis on efficient utilization of hospital resources has been seen in recent years. However, reduced screening for blunt vertebral artery injury (BVAI) may result in missed diagnoses if risk factors are not fully understood. The authors examined the records of blunt trauma patients with fractures near the craniocervical junction who underwent CTA at a single institution to better understand the risk of BVAI imposed by occipital condyle fractures (OCFs). METHODS The authors began with a query of their prospectively collected trauma registry to identify patients who had been screened for BVAI using ICD-9-CM diagnostic codes...
August 3, 2018: Journal of Neurosurgery. Spine
Tarun Dusad, Vishal Kundnani, Shumayou Dutta, Ankit Patel, Gaurav Mehta, Mahendra Singh
STUDY DESIGN: Retrospective study. PURPOSE: To evaluate the clinico-radiological efficacy of stand-alone minimally invasive transarticular screw (MIS-TAS) fixation without supplemental Gallie fixation in the management of mobile C1-C2 instability. OVERVIEW OF LITERATURE: Data evaluating the efficacy and feasibility of MIS-TAS in the literature is scanty. METHODS: Patients with mobile atlantoaxial instability and >2 years follow-up were included and managed by stand-alone TAS fixation using the Magerl technique and morselized allograft without additional fixation...
August 2018: Asian Spine Journal
Victoria Schunemann, Jeeho Kim, David Dornbos, Shahid M Nimjee
BACKGROUND: Bow Hunter's Syndrome (BHS) or rotational vertebral artery occlusion (RVAO) is a rare syndrome of vertebrobasilar insufficiency due to compression or occlusion of the contralateral vertebral artery with cervical axial rotation. Compression at the C2-3 level, the junction between the axial and subaxial spine, has not been described. Management may include medical treatment with antiplatelet medications, surgical fusion, or vertebral artery decompression. CASE DESCRIPTION: The patient presented with dizziness and loss of consciousness with axial head rotation to the left...
July 24, 2018: World Neurosurgery
Mark E Lytle, James West, Jason N Burkes, Besem Beteck, Tammy Fisher, Yahya Daoud, Dennis R Gable, William P Shutze
BACKGROUND: Blunt cerebrovascular injury (BCVI), although rare, is more common than previously thought and carries a substantial stroke and mortality risk. The purpose of our study was to evaluate the differences between blunt carotid artery (CA) and vertebral artery (VA) injuries, assess the stroke and death rates related to these injuries, and identify the relationship of Injury Severity Score (ISS) with stroke and mortality in BCVI. MATERIAL AND METHODS: Using a retrospective review of the Trauma Registry at a Level I Trauma Center, we identified patients with BCVI...
July 24, 2018: Annals of Vascular Surgery
Nupur Pruthi, Lokesh Nehete, Tanmoy Maity, Rose Dawn, Yogita Ravindranath, Roopa Ravindranath, Mariamma Philips
Background: The most feared complication while inserting C2 screws is vertebral artery injury. This article proposes predicting the position of the vertebral artery on a true lateral X-ray of the axis vertebra from the background information acquired from the computed tomography (CT) scan utilizing fluoroscopy. Methods: Spiral CT scans of 33 C2 vertebrae were performed utilizing a 16-slice CT scanner lateral X-rays of C2 were then obtained before and after painting the vertebral artery grooves with barium...
2018: Surgical Neurology International
Hui Wang, Rui Xue, Lumei Wu, Wenyuan Ding, Lei Ma
The aim of this study was to compare clinical and radiological outcomes between modified Gallie graft fusion-wiring technique and posterior cervical screw constructs for Type II odontoid fractures, and hope to provide references in decision making and surgical planning for both spinal surgeons and surgically treated patients.This is a retrospective study. By retrieving the medical records from January 2005 to July 2015 in our hospital, 53 Type II odontoid fracture patients were reviewed. According to the instrumentation type, patients were divided into 2 groups: Wiring group and Screw group...
July 2018: Medicine (Baltimore)
Aaron Winn, Anthony M Durso, Catalina Restrepo Lopera, Felipe Munera
Blunt cerebrovascular injury involves injury to the carotid and/or vertebral arteries sustained via generalized multitrauma or directed blunt craniocervical trauma. Stroke remains the most consequential outcome. Timely diagnosis and initiation of treatment before the development of neurologic complications has a well-established role in decreasing morbidity and mortality. This article presents evidence and controversies surrounding the optimization of diagnostic imaging for suspected blunt cerebrovascular injury...
August 2018: Neuroimaging Clinics of North America
Yasuhisa Kanematsu, Junichiro Satomi, Masaaki Korai, Toshiyuki Okazaki, Izumi Yamaguchi, Yoshiteru Tada, Masaaki Uno, Shinji Nagahiro, Yasushi Takagi
Surgery for- and endovascular treatment of vertebral artery (VA) dissecting aneurysms involving the origin of the posterior inferior cerebellar artery (PICA) remain challenging. Their ideal treatment is complete isolation of the aneurysm by surgical or endovascular trapping plus PICA reconstruction. However, postoperative lower cranial nerve palsy and medullary infarction are potential complications. We report four patients with VA dissecting aneurysms involving the PICA origin who were treated by occipital artery (OA)-PICA bypass followed by proximal occlusion of the VA and clip ligation of the PICA origin instead of trapping...
July 12, 2018: Neurologia Medico-chirurgica
Hridayesh Pratap Malla, Sung Bum Kim, Jun Sung Won, Man Kyu Choi
Objective: The purpose of this study was to provide anatomical data on the dimensions and location of the subaxial transverse foramen (TF) in relation to surgical landmarks routinely used during anterior cervical procedures. Methods: A total of 116 patients who underwent preoperative computed tomography (CT) evaluations for degenerative cervical disease were enrolled. Axial and coronal CT images of the cervical vertebrae from C3 to C6 were analyzed to measure interforaminal distance, the TF distance from the anterior and posterior vertebral body margin, TF dimensions, and the TF medial margin from the tip and medial margin of the uncus...
June 2018: Neurospine
Rathna Paramaswamy
Complex cervical spine fractures are a serious complications of maxillofacial trauma and associated with high mortality and neurological morbidity. Strict vigilance in preventing further insult to the cervical spine is a crucial step in managing patients who are at risk for neurologic compromise. We report a rare case of a right transverse process of atlas fracture with right-sided vertebral artery injury that was associated with a comminuted fracture of the body and angle of the mandible, which restricted mouth opening...
June 2018: Journal of Dental Anesthesia and Pain Medicine
Christoph Scholz, Jan-Helge Klingler, Christian Scheiwe, Yashar Naseri, Waseem Masalha, UIrich Hubbe
OBJECTIVE:  We report on our experiences of navigated posterior C1-C2 spondylodesis in the elderly (≥ 70 years of age). PATIENTS:  This retrospective cohort study evaluated all patients ≥ 70 years of age treated with navigated posterior spondylodesis C1-C2 (at the most to C3) from 2008 to 2015 with a minimum follow-up of 1 year. Minor and major complications within 30 days after surgery, patient outcome, and the rate of solid fusion in computed tomography were recorded...
July 4, 2018: Journal of Neurological Surgery. Part A, Central European Neurosurgery
Zoltán Bajkó, Smaranda Maier, Anca Moţăţăianu, Rodica Bălaşa, Smaranda Vasiu, Adina Stoian, Sebastian Andone
Introduction: Lesions of the carotid and vertebral arteries secondary to direct trauma, called blunt cerebrovascular injuries (BCVI) are relatively rare and are markedly different from spontaneous dissections. Ischaemic stroke is a significant complication, with high morbidity and mortality rates. The basis of a diagnosis relies on appropriate, high sensitivity imaging screening. Case report: We present the case of a 31 years old male patient with polytraumatism secondary to a motor vehicle accident, who was admitted to an orthopaedic clinic for multiple lower extremity fractures...
January 2018: Journal of Critical Care Medicine
Rongjun Qian, Zhixiao Li, Ming Li
Vertebral arteriovenous fistula (AVF), a complication of a vertebral artery injury (VAI), is a rare but serious complication of upper cervical spine fixation surgery. We report a case of a 59-year-old female patient who had a vertebral AVF following transpedicular occipitocervical fixation surgery. Endovascular embolization of the AVF was successfully performed using ethylene vinyl alcohol. From this case we learned that preoperative evaluation of the course of the vertebral artery is necessary, and vertebral artery embolism is an effective and safe method to treat vertebral AVF after proof of a patent second vertebral artery...
July 2, 2018: Journal of Neurological Surgery. Part A, Central European Neurosurgery
Linkai Jing, Zhenxing Sun, Peihai Zhang, James Wang, Guihuai Wang
OBJECTIVE: This study aimed to evaluate the accuracy of screw placement and clinical outcomes in patients undergoing occipitocervical fusion. METHODS: Patients who underwent occipitocervical fusion with O-arm-based navigation were retrospectively reviewed between January 2015 and December 2017. The patients' characteristics, clinical and radiographic outcomes, and surgical complications were recorded and analyzed. Cervical screw insertion accuracy was evaluated using the Richter scale...
June 23, 2018: World Neurosurgery
Madhivanan Karthigeyan, Pravin Salunke, Mandeep Singh Kataria
Congenital craniovertebral junction deformities can be associated with an anomalous vertebral artery (VA). At times, the artery crosses the joint posteriorly (i.e., persistent first intersegmental artery) and is at risk during posterior approach. We report a new variant, wherein the bilateral VA coursed medially after exiting the C3 transverse foramina to lie beneath C2 pars interarticularis and enter the foramen magnum (without passing through C2 transverse foramen anywhere along its course). This is possibly a result of bilateral persistent second intersegmental arteries...
June 23, 2018: Acta Neurochirurgica
Samer Amhaz-Escanlar, Alberto Jorge-Mora, Teresa Jorge-Mora, Manuel Febrero-Bande, Maximo-Alberto Diez-Ulloa
PURPOSE: Lateral mass screws combined with rods are the standard method for posterior cervical spine subaxial fixation. Several techniques have been described, among which the most used are Roy Camille, Magerl, Anderson and An. All of them are based on tridimensional angles. Reliability of freehand angle estimation remains poorly investigated. We propose a new technique based on on-site spatial references and compare it with previously described ones assessing screw length and neurovascular potential complications...
June 20, 2018: European Spine Journal
Ayumu Yamaoka, Kei Miyata, Naofumi Bunya, Hirotoshi Mizuno, Hideto Irifune, Naoya Yama, Yukinori Akiyama, Takeshi Mikami, Masahiko Wanibuchi, Nobuhiro Mikuni
In blunt cerebrovascular injury, reported traumatic basilar artery occlusions have involved dissection of the basilar artery, distal embolization due to traumatic vertebral artery dissection, or entrapment of the basilar artery into the clivus fracture. To date, however, there are no reports of traumatic basilar artery entrapment without a clivus fracture. Here, we report the first case of traumatic basilar artery occlusion caused by entrapment into an originally existing bone defect. A 67-year-old man with a history of treatment for intracranial aneurysm suffered multiple traumatic injuries in a fall...
June 20, 2018: Neurologia Medico-chirurgica
Ahmad Iyad Mubarak, Ajaykumar C Morani
Klippel-Feil syndrome is an uncommon anomaly that may be asymptomatic. Early clinical signs such as restricted neck motion or short neck can be subtle and incorrectly treated as spasms. High incidence of associated craniovertebral junction (CVJ) anomalies such as occipitalized atlas predisposes them to serious neurologic complications requiring invasive procedures and surgeries. However, these often have anomalous vertebral artery course which is more prone to injury during CVJ procedures, and also sparsely known in radiology literature...
April 2018: Radiology Case Reports
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