Abstract
Introduction
The craniovertebral junction is anatomically complicated. Representative vertebral artery (VA) variations include the persistent first intersegmental artery (FIA), fenestration of the VA above and below C1 (FEN), posterior inferior cerebellar artery (PICA) from C1/2, and high-riding VA (HRVA). The ponticulus posticus (PP) is a well-known osseous anomaly at C1. Although those anomalies are frequent in patients with cervical deformity, the prevalence of these in subjects with normal cervical spines is still unknown. The aim of this study is to investigate the variations and prevalence of vascular and osseous anomalies based on three-dimensional computed tomographic (3D CT) angiography in patients without any cervical diseases, such as rheumatoid arthritis, Klippel-Feil syndrome, or Down syndrome.
Methods
Eligible subjects were patients who underwent 3D CT angiography by the Department of Otorhinolaryngology and Internal Medicine from January 2009 to October 2013 in our institution. The authors defined a HRVA as a C2 pedicle with a maximum diameter of 4 mm or less.
Results
Among 480 subjects with a mean age of 63.1 years, 387 patients were eligible. One hundred and eighteen subjects were female, and 269 were male. HRVA was observed in 10.1 % of patients (39 out of 387 cases), FIA in 1.8 % (7 cases), FEN in 1.3 % (5 cases), and PICA in 1.3 % (5 cases). PP was observed in 6.2 % of patients (24 cases).
Conclusion
According to past reports, many VA anomalies could be attributed to congenital or acquired conditions (e.g., rheumatoid arthritis). However, VA anomalies appear to exist even in patients without any such cervical diseases.
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References
Bertalanffy H, Eggert HR (1989) Complications of anterior cervical discectomy without fusion in 450 consecutive patients. Acta Neurochir 99(1–2):41–50
Burke JP, Gerszten PC, Welch WC (2005) Iatrogenic vertebral artery injury during anterior cervical spine surgery. Spine J 5(5):508–514. doi:10.1016/j.spinee.2004.11.015, discussion 514
Cosgrove GR, Theron J (1987) Vertebral arteriovenous fistula following anterior cervical spine surgery. Report of two cases. J Neurosurg 66(2):297–299. doi:10.3171/jns.1987.66.2.0297
de los Reyes RA, Moser FG, Sachs DP, Boehm FH (1990) Direct repair of an extracranial vertebral artery pseudoaneurysm: case report and review of the literature. Neurosurgery 26(3):528–533
Garcia Alzamora M, Rosahl SK, Lehmberg J, Klisch J (2005) Life-threatening bleeding from a vertebral artery pseudoaneurysm after anterior cervical spine approach: endovascular repair by a triple stent-in-stent method. Case report. Neuroradiology 47(4):282–286. doi:10.1007/s00234-005-1343-2
Smith MD, Emery SE, Dudley A, Murray KJ, Leventhal M (1993) Vertebral artery injury during anterior decompression of the cervical spine. A retrospective review of ten patients. J Bone Joint Surg Br Vol 75(3):410–415
Tumialan LM, Wippold FJ 2nd, Morgan RA (2004) Tortuous vertebral artery injury complicating anterior cervical spinal fusion in a symptomatic rheumatoid cervical spine. Spine 29(16):E343–E348
Tokuda K, Miyasaka K, Abe H, Abe S, Takei H, Sugimoto S, Tsuru M (1985) Anomalous atlantoaxial portions of vertebral and posterior inferior cerebellar arteries. Neuroradiology 27(5):410–413
Mandel IM, Kambach BJ, Petersilge CA, Johnstone B, Yoo JU (2000) Morphologic considerations of C2 isthmus dimensions for the placement of transarticular screws. Spine 25(12):1542–1547
Neo M, Matsushita M, Iwashita Y, Yasuda T, Sakamoto T, Nakamura T (2003) Atlantoaxial transarticular screw fixation for a high-riding vertebral artery. Spine 28(7):666–670. doi:10.1097/01.BRS.0000051919.14927.57
Paramore CG, Dickman CA, Sonntag VK (1996) The anatomical suitability of the C1-2 complex for transarticular screw fixation. J Neurosurg 85(2):221–224. doi:10.3171/jns.1996.85.2.0221
Pyo J, Lowman RM (1959) The ponticulus posticus of the first cervical vertebra. Radiology 72(6):850–854. doi:10.1148/72.6.850
Young JP, Young PH, Ackermann MJ, Anderson PA, Riew KD (2005) The ponticulus posticus: implications for screw insertion into the first cervical lateral mass. J Bone Joint Surg Am Vol 87(11):2495–2498. doi:10.2106/JBJS.E.00184
Yamazaki M, Okawa A, Hashimoto M, Aiba A, Someya Y, Koda M (2008) Abnormal course of the vertebral artery at the craniovertebral junction in patients with Down syndrome visualized by three-dimensional CT angiography. Neuroradiology 50(6):485–490. doi:10.1007/s00234-008-0368-8
Yamazaki M, Okawa A, Furuya T, Sakuma T, Takahashi H, Kato K, Fujiyoshi T, Mannoji C, Takahashi K, Koda M (2012) Anomalous vertebral arteries in the extra- and intraosseous regions of the craniovertebral junction visualized by 3-dimensional computed tomographic angiography: analysis of 100 consecutive surgical cases and review of the literature. Spine 37(22):E1389–E1397. doi:10.1097/BRS.0b013e31826a0c9f
Miyata M, Neo M, Ito H, Yoshida M, Miyaki K, Fujibayashi S, Nakayama T, Nakamura T (2008) Is rheumatoid arthritis a risk factor for a high-riding vertebral artery? Spine 33(18):2007–2011. doi:10.1097/BRS.0b013e31817c6bf7
Uchino A, Saito N, Watadani T, Okada Y, Kozawa E, Nishi N, Mizukoshi W, Inoue K, Nakajima R, Takahashi M (2012) Vertebral artery variations at the C1-2 level diagnosed by magnetic resonance angiography. Neuroradiology 54(1):19–23. doi:10.1007/s00234-011-0849-z
Wakao N, Takeuchi M, Kamiya M, Aoyama M, Hirasawa A, Sato K, Takayasu M (2014) Variance of cervical vertebral artery measured by CT angiography and its influence on C7 pedicle anatomy. Spine 39(3):228–232. doi:10.1097/BRS.0000000000000120
Yukawa Y, Kato F, Yoshihara H, Yanase M, Ito K (2006) Cervical pedicle screw fixation in 100 cases of unstable cervical injuries: pedicle axis views obtained using fluoroscopy. J Neurosurg Spine 5(6):488–493. doi:10.3171/spi.2006.5.6.488
Abumi K, Kaneda K, Shono Y, Fujiya M (1999) One-stage posterior decompression and reconstruction of the cervical spine by using pedicle screw fixation systems. J Neurosurg 90(1 Suppl):19–26
Roosen K, Trauschel A, Grote W (1982) Posterior atlanto-axial fusion: a new compression clamp for laminar osteosynthesis. Arch Orthop Trauma Surg (Archiv fur orthopadische und Unfall-Chirurgie) 100(1):27–31
Harms J, Melcher RP (2001) Posterior C1-C2 fusion with polyaxial screw and rod fixation. Spine 26(22):2467–2471
Stillerman CB, Wilson JA (1993) Atlanto-axial stabilization with posterior transarticular screw fixation: technical description and report of 22 cases. Neurosurgery 32(6):948–954, discussion 954-945
Padget DH (1956) The cranial venous system in man in reference to development, adult configuration, and relation to the arteries. Am J Anat 98(3):307–355. doi:10.1002/aja.1000980302
Hasan M, Shukla S, Siddiqui MS, Singh D (2001) Posterolateral tunnels and ponticuli in human atlas vertebrae. J Anat 199(Pt 3):339–343
Acknowledgments
This study was supported by a Grant-in-Aid for Scientific Research, Japan (2012).
Ethical standards and patient consent
We declare that all human and animal studies have been approved by the Institutional Review Board of Aichi Medical University and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. We declare that all patients gave informed consent prior to inclusion in this study.
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We declare that we have no conflict of interest.
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Wakao, N., Takeuchi, M., Nishimura, M. et al. Vertebral artery variations and osseous anomaly at the C1-2 level diagnosed by 3D CT angiography in normal subjects. Neuroradiology 56, 843–849 (2014). https://doi.org/10.1007/s00234-014-1399-y
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DOI: https://doi.org/10.1007/s00234-014-1399-y