A Report on the Safety of Unilateral Vertebral Artery Ligation During Cervical Spine Surgery

Abstract

A vertebral artery could be ligated uneventfully when the diameter of the vertebral artery was not larger than the one not involved. Where vertebral artery ligation could not be avoided, it should be confirmed by preoperative angiogram that the other vertebral artery is large enough and that simultaneous occlusion testing of the involved vertebral artery is uneventful.

Safety of Unilateral Endovascular Occlusion of the Cervical Segment of the Vertebral Artery without Antecedent Balloon Test Occlusion

“…4,13 The favorable safety profile demonstrated in our study of 59 patients is consistent with these studies as well as a recent report by Kansagra et al, 14 in which 100 traumatic arterial cervicocerebral vascular injuries were endovascularly treated with a low rate of immediate or delayed neurovascular complications.…”

“…1,[4][5][6] In some cases, surgical or endovascular vessel sacrifice can obviate complex skull base surgery. Dissecting aneurysms of the intracranial vertebral artery are particularly difficult to reconstruct surgically and have been treated successfully with proximal vertebral artery or endovascular segmental occlusion of the affected vessel.…”

“…No cases of cerebral or spinal cord ischemia were reported in this study. 4 Given this information and our own personal experience, we believe that unilateral therapeutic occlusion of a cervical vertebral artery is safe as long as the contralateral vertebral artery is patent to the level of the vertebrobasilar junction and there is no angiographic evidence of vascular supply to the spinal cord arising from the target segment of the affected vessel.…”

Distal Embolic Brain Infarction Due to Recanalization of Asymptomatic Vertebral Artery Occlusion Resulting From Cervical Spine Injury: A Case Report

“…This is based on the premise that occlusion of unilateral VA is generally well tolerated. The presence of VA agenesis has been found to be 1.8% to 3.1% in autopsy study, 22 and unilateral VA dominance is uncommon, Hoshino et al 23 performed unilateral VA ligation on 15 patients without adverse sequelae on long-term follow-up. However, routine embolization introduces the risk that the contralateral VA may acquire transient flow disturbances, resulting in infarction.…”

Poor surgical technique in cervical plating leading to vertebral artery injury and brain stem infarction—case report

“…Vertebral artery injury during lateral mass plating is very rare [24], and most cases of vertebral artery injury developed during pedicle screwing to involve arterial wall tearing, or rupture during drilling or screw insertion. The management of such an injury usually involves packing the drill hole with screw or bone wax, sometimes ligation, or rarely, direct repair of injured vertebral artery [5,12,28]. Others have occluded the vertebral artery with intravascular embolization after surgery [3].…”