Preoperative Evaluation of the Vertebral Arteries and Posterior Portion of the Circle of Willis for Cervical Spine Surgery Using 3-Dimensional Computed Tomography Angiography

Sano, Atsuki; Hirano, Tôru; Watanabe, Kei; Izumi, Tohru; Endo, Naoto; Ito, Takui; Inagawa, Shoichi

doi:10.1097/brs.0b013e318296e542

Cited by 9 publications

(13 citation statements)

References 28 publications

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“…[7][8][9] In patients with occlusion of both vertebral arteries, both the posterior communicating artery (PCoA) and the first segment of the posterior cerebral artery (P1), which constitute the posterior part of the Circle of Willis, are essential collateral vessels for the basilar artery. 5,7 Although the number of reports of vertebral artery injury by posterior instrumentation of the cervical spine has been steadily increasing, 2,4,5,10 there has only been one which describes the frequency of an anomalous vertebral artery in combination with variations in the posterior portion of the Circle of Willis: this concentrated on the blood supply to the hindbrain. 5 In this study, we used 3D-CTA to describe these anomalies and assess the associated problems.…”

mentioning

confidence: 98%

“…5,7 Although the number of reports of vertebral artery injury by posterior instrumentation of the cervical spine has been steadily increasing, 2,4,5,10 there has only been one which describes the frequency of an anomalous vertebral artery in combination with variations in the posterior portion of the Circle of Willis: this concentrated on the blood supply to the hindbrain. 5 In this study, we used 3D-CTA to describe these anomalies and assess the associated problems.…”

mentioning

confidence: 98%

“…It has been suggested that pre-operative evaluation for anomalies of the vertebral arteries using threedimensional computed tomographic angiography (3D-CTA) can reduce this risk. 4,5 If a vertebral artery is occluded or stenotic, flow may still be possible through collateral vessels, which can respond quickly to low perfusion pressure by a simple reversal of flow. 6 Therefore, the size and patency of these collateral pathways may be a risk factor for cerebral infarction in patients whose vertebral arteries have been occluded or rendered stenotic by cervical instrumentation.…”

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confidence: 99%

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Anomalous vertebral and posterior communicating arteries as a risk factor in instrumentation of the posterior cervical spine

Nagahama

Sudo

Abumi

et al. 2014

The Bone & Joint Journal

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We investigated the incidence of anomalies in the vertebral arteries and Circle of Willis with three-dimensional CT angiography in 55 consecutive patients who had undergone an instrumented posterior fusion of the cervical spine. We recorded any peri-operative and post-operative complications. The frequency of congenital anomalies was 30.9%, abnormal vertebral artery blood flow was 58.2% and vertebral artery dominance 40%. The posterior communicating artery was occluded on one side in 41.8% of patients and bilaterally in 38.2%. Variations in the vertebral arteries and Circle of Willis were not significantly related to the presence or absence of posterior communicating arteries. Importantly, 18.2% of patients showed characteristic variations in the Circle of Willis with unilateral vertebral artery stenosis or a dominant vertebral artery, indicating that injury may cause lethal complications. One patient had post-operative cerebellar symptoms due to intra-operative injury of the vertebral artery, and one underwent a different surgical procedure because of insufficient collateral circulation. Pre-operative assessment of the vertebral arteries and Circle of Willis is essential if a posterior spinal fusion with instrumentation is to be carried out safely.

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confidence: 98%

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confidence: 98%

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confidence: 99%

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Anomalous vertebral and posterior communicating arteries as a risk factor in instrumentation of the posterior cervical spine

Nagahama

Sudo

Abumi

et al. 2014

The Bone & Joint Journal

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“…Regarding vertebral artery variations, only 1 patient with bilateral vertebral arteries entering the transverse foramen at the C4 level was observed in this series. Because a high frequency of anomalous vertebral arteries in the V3 segment associated with atlanto-axial instability and congenital or acquired conditions (e.g., congenital deformity, Down syndrome) was reported 21,22) , careful preoperative study using thin-slice CT angiography is recommended to confirm sufficient bone structure and the existence of the anomalous vertebral artery or osseous anomaly 13) , especially before screwrod instrumented fusion. Unintended fusion in an adjacent segment has been reported after O-C fusion in children in studies involving more than 7 years of follow-up 23) .…”

Section: Fusion Rates and Complications Related To Fusion Surgery In mentioning

confidence: 99%

“…Preoperative study using thin-slice CT angiography was routinely performed to confirm the osseous anomaly or anomalous course of the vertebral arteries since 2008 13) . The initial surgical procedures were O-C fusion for 7 patients and atlanto-axial fusion (C1-2 fusion) for 6 patients.…”

Section: Surgical Procedures and Postoperative Treatmentmentioning

confidence: 99%

Radiographic Outcomes of Upper Cervical Fusion for Pediatric Patients Younger Than 10 Years

Watanabe

Hirano

Katsumi

et al. 2017

Spine Surg Relat Res

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Abstract:Purpose: This study aimed to investigate radiographic outcomes after posterior spinal fusion (PSF) for pediatric patients younger than 10 years with upper cervical disorders. Methods: Thirteen patients (mean age at surgery, 5.9 years; range, 1 to 9 years) who underwent PSF with a minimum of 2 years of follow-up (mean, 5.8 years) were included. Diagnoses were atlanto-axial instability due to congenital disorders for 11 patients and atlanto-axial rotatory fixation for 2 patients. The fusion area was occipito-cervical for 7 patients and C1/2 for 6 patients. PSF was performed using rigid screw-rod constructs for 6 patients and conventional techniques for 7 patients. Ten patients required halo immobilization after surgery. Fusion status, perioperative complications, radiographic alignment, and range of motion (ROM) from C2 to C7 were evaluated. Results: Twelve patients successfully achieved bony fusion (fusion rate, 92%), but complications occurred in 5 patients. Regarding radiographic measures (preoperative/postoperative/final follow-up), the mean atlanto-dental interval was significantly reduced (8.0 mm/2.7 mm/3.5 mm) and the C2-7 ROM was increased (from 49.4 degrees to 66.0 degrees) at the final follow-up (both comparisons, p<0.05). Sagittal alignment was unchanged. Conclusion: Use of rigid screw-rod instrumentation in the upper cervical spine with careful radiological evaluation is amenable for pediatric patients younger than 10 years. However, conventional procedures such as wiring fixation with rigid external immobilization are still alternative options for preventing serious neurological and vascular complications.

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Variations of transverse foramina in cervical vertebrae: what happens to the vertebral artery?

et al. 2018

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Vertebral artery injury is not common but may be a disastrous complication during cervical spine surgery. Proper preoperative planning is essential for any surgeon and exact knowledge of the anatomy in each patient is essential. This study strongly recommends the preoperative use of a CTa when suspicion of a variation is present and implied by a foramen variation. These slides can be retrieved under Electronic Supplementary Material.

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Preoperative Evaluation of the Vertebral Arteries and Posterior Portion of the Circle of Willis for Cervical Spine Surgery Using 3-Dimensional Computed Tomography Angiography

Cited by 9 publications

References 28 publications

Anomalous vertebral and posterior communicating arteries as a risk factor in instrumentation of the posterior cervical spine

Anomalous vertebral and posterior communicating arteries as a risk factor in instrumentation of the posterior cervical spine

Radiographic Outcomes of Upper Cervical Fusion for Pediatric Patients Younger Than 10 Years

Variations of transverse foramina in cervical vertebrae: what happens to the vertebral artery?

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