scholarly journals Congenital Bilateral C2 Transverse Foramina Stenosis Causing Adult-Onset Vertebrobasilar Insufficiency and Posterior Circulation Stroke

2017 ◽  
Vol 9 (2) ◽  
pp. 137-142 ◽  
Author(s):  
Ajeet Gordhan ◽  
Catherine Lockhart
Keyword(s):  
Computed Tomography ◽  
Vertebral Artery ◽  
Head And Neck ◽  
Computed Tomography Angiography ◽  
Congenital Anomalies ◽  
Brain Mri ◽  
Posterior Circulation ◽  
Vertebrobasilar Insufficiency ◽  
Adult Onset ◽  
Vertebral Arteries

Vertebrobasilar insufficiency leading to posterior circulation infarcts caused by congenital hypoplasia of the bilateral transverse foramina at the C2 level, affecting the caliber and flow of the bilateral distal cervical vertebral arteries in an adult, has not been previously reported. A 41-year-old male presented with episodic dizziness for a period of 1 year prior to consultation. Computed tomography angiography of the head and neck demonstrated congenital hypoplasia of the bilateral C2 transverse foramina, with absence of the vertebral arteries in each of the foramina and collateral reconstitution of diminutive intracranial vertebral artery segments. Brain MRI showed postinfarction encephalomalacia in the bilateral cerebellar hemispheres. The patient was considered not a surgical or endovascular candidate and was managed conservatively with antiplatelet therapy. Congenital anomalies of the bilateral cervical transverse foramina may present with vertebrobasilar insufficiency and infarction in adulthood.

Ascending pharyngeal-vertebral anastomosis demonstrated by computed tomography angiography of the ascending pharyngeal artery: a case report

2011 ◽  
Vol 52 (9) ◽  
pp. 951-953
Author(s):  
Yukihisa Sato ◽  
Nobuo Kashiwagi ◽  
Katsuyuki Nakanishi ◽  
Kunitoshi Yoshino ◽  
Noriyuki Tomiyama1
Keyword(s):  
Computed Tomography ◽  
Case Report ◽  
Carotid Artery ◽  
Vertebral Artery ◽  
Head And Neck ◽  
Computed Tomography Angiography ◽  
Ascending Pharyngeal Artery ◽  
Neck Area ◽  
Intracranial Arteries ◽  
The Right

Ascending pharyngeal-vertebral anastomosis has been identified by angiography of the carotid artery in several cases. We present a case of ascending pharyngeal-vertebral anastomosis that was found incidentally in computed tomography angiography of the ascending pharyngeal artery. Images revealed that the anastomosis formed through the hypoglossal branch of the neuromeningeal trunk. The anastomosis seemed to be associated with hypoplasia of the right vertebral artery. Interventional radiologists should be aware of this dangerous anastomotic route of the APA to the VA. Discovery of hypoplasia of the major intracranial arteries before intra-arterial chemotherapy or embolization in head and neck area may avoid subsequent complications.

scholarly journals Resolution of retro-odontoid cyst in a patient with atlanto-occipital assimilation after occipitocervical fixation

2021 ◽  
Vol 12 ◽  
pp. 34
Author(s):  
Masahiro Kawanishi ◽  
Yutaka Ito ◽  
Hidekazu Tanaka ◽  
Kunio Yokoyama ◽  
Makoto Yamada ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Vertebral Artery ◽  
Computed Tomography Angiography ◽  
Congenital Anomalies ◽  
Craniovertebral Junction ◽  
Case Description ◽  
Occipitocervical Fixation ◽  
Neurovascular Injury

Background: Fusion of the atlas with the lower part of the occiput is clinically known as atlanto-occipital assimilation (AOA) or atlas occipitalization. This can be either partial or complete depending on the extent of fusion. AOA is one of the most common congenital anomalies of the craniovertebral junction and is usually asymptomatic. Case Description: An 80-year-old female presented with a retro-odontoid cyst in conjunction with AOA. Following posterior occipitocervical fixation without resection of the cyst, the patient improved, and the postoperative MR documented cyst resolution. Conclusion: Patients with AOA and a retro-odontoid cyst may be successfully managed with occipitocervical fixation without resection of the cyst. However, we would recommend preoperative computed tomography angiography to document whether the vertebral artery follows an anomalous course to avoid an intraoperative neurovascular injury.

Computed Tomography Angiography in Head and Neck Emergencies

2017 ◽  
Vol 38 (4) ◽  
pp. 345-356 ◽  
Author(s):  
Nikhil Madhuripan ◽  
Oliver David Atar ◽  
Richard Zheng ◽  
Mary Tenenbaum
Keyword(s):  
Computed Tomography ◽  
Head And Neck ◽  
Computed Tomography Angiography

Cerebral Blood Flow Volume in Posterior Circulation Ischemic Disorders

2021 ◽  
pp. 154431672110539
Author(s):  
Anastasiya Yu. Vishnyakova ◽  
Nataliya M. Medvedeva ◽  
Alexander B. Berdalin ◽  
Svetlana E. Lelyuk ◽  
Vladimir G. Lelyuk
Keyword(s):  
Blood Flow ◽  
Healthy Volunteers ◽  
Internal Carotid ◽  
Duplex Sonography ◽  
Posterior Circulation ◽  
Control Group ◽  
Vertebrobasilar Insufficiency ◽  
Flow Volume ◽  
Blood Flow Volume ◽  
Vertebral Arteries

Objective: The aim of this study was to determine blood flow volume (BFV) in the normal state and its features in patients with acute posterior circulation ischemic strokes (PCIS) and vertebrobasilar insufficiency (VBI) using color duplex sonography (DS).Methods: The study included DS data from 96 patients with verified PCIS (66 men and 30 women, aged 64±13 years) and 29 adults with VBI (17 men and 12 women, aged 66±11 years). The control group consisted of 65 healthy male volunteers of different ages.Results: In asymptomatic healthy volunteers, there was a significant decrease in BFV in the internal carotid artery (ICA) with age (502 ml/min in young people, 465 ml/min in the older subgroup) with rS = −0.24 ( p = 0.05), and the aggregated BFV in the vertebral arteries (VAs) turned out to be almost constant (141–143 ml/min). In patients with VBI, the aggregated BFV in the VAs (144 ml/min) did not differ from that in healthy volunteers, but the BFV values in the ICAs were significantly lower (325 ml/min). In patients with PCIS, the aggregated BFV in the ICAs was also significantly lower (399 ml/min) than in the control group but did not significantly differ from that in patients with VBI. In patients with PCIS, there was a significant decrease in the aggregated BFV in the VAs (105 ml/min), which distinguished this group from other examined patients.Conclusions: A significant decrease the BFV in the VA was observed only in patients with PCIS and was associated with the presence of steno-occlusive diseases (SOD) more often in the left VA. Patients with VBI had the most pronounced decrease in BFV in the ICA.

Vertebral Artery Disease

2015 ◽  
Author(s):  
Gregory J. Pearl ◽  
William P. Shutze
Keyword(s):  
Vertebral Artery ◽  
Posterior Circulation ◽  
Circulation System ◽  
Common Disease ◽  
Vertebrobasilar Insufficiency ◽  
Disease Patterns ◽  
Collateral Pathways ◽  
Artery Disease ◽  
The Right ◽  
Evaluation Patterns

Vertebral artery disease (VAD) is a significant cause of severe symptoms or stroke. Approximately 25 to 30% of strokes involve the posterior circulation system; VAD will be present in 20% of these and will be the source in about 10%. The ability to properly diagnose, manage, and treat VAD is an important skill for practitioners caring for patients with extracranial cerebral occlusive disease. This review covers anatomy, presentations of VAD, evaluation, patterns of disease, treatment, and other vertebral artery (VA) syndromes. Tables outline symptoms and differential diagnoses of vertebrobasilar insufficiency, etiologies of VA compression syndromes, posterior circulation cerebrovascular accident symptoms and associated syndromes, and ultrasonography velocity and VA stenosis. Figures show the anatomy of the VA, circle of Willis, aberrant arteries, VA compression, ischemic posterior circulation, collateral pathways to the VA, common disease patterns in VAD, VA to carotid artery anastomosis, incision for the V3 bypass, VA aneurysm, VA dissection, angiography of the right VA, giant cell arteritis, and fibromuscular dysplasia. Radiologic videos are provided. This review contains 15 figures, 6 tables, 7 videos, and 71 references.

scholarly journals Left Vertebral Artery to Common Carotid Artery Transposition in a Patient With Bilateral Vertebral Insufficiency: 3-Dimensional Operative Video

2020 ◽  
Vol 19 (3) ◽  
pp. E301-E302
Author(s):  
Sirin Gandhi ◽  
Claudio Cavallo ◽  
Justin R Mascitelli ◽  
Michael J Nanaszko ◽  
Xiaochun Zhao ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Vertebral Artery ◽  
Common Carotid Artery ◽  
Suture Technique ◽  
Posterior Circulation ◽  
Left Vertebral Artery ◽  
Vertebrobasilar Insufficiency ◽  
Subclavian Steal ◽  
Bypass Patency ◽  
Patient Consent

Abstract Extracranial vertebral artery (VA) atherosclerosis is responsible for 14% to 32% of posterior circulation infarctions.1 In the posterior circulation, narrowing of the VA > 30% is significantly associated with strokes. Subclavian artery (SCA) atherosclerosis can produce subclavian steal. Retrograde VA flow around an occluded SCA decreases blood flow to the posterior circulation and causes vertebrobasilar insufficiency (VBI). Flow augmentation to the posterior circulation can be achieved by VA endarterectomy, arterial stenting, VA-common carotid artery (CCA) transposition, or bypass using an interposition graft.2,3 This video illustrates microsurgical revascularization of the proximal VA with VA-CCA transposition. A 58-yr-old man with a prior stroke and chronic right VA occlusion presented with dysarthria and gait instability. Angiographic evaluation confirmed complete midcervical right VA occlusion and left SCA occlusion proximal to VA origin, with subclavian steal. After obtaining patient consent and a failed attempt at endovascular recanalization of the left SCA, a left VA-CCA end-to-side transposition was performed. Neck dissection exposed the left CCA. The thyrocervical trunk served as a landmark to identify the SCA, which was traced proximally to the VA origin. After proximal occlusion, the VA was transected and “fish-mouthed” for end-to-side anastomosis to CCA. An intraluminal, continuous suture technique was used to sew the back walls of this anastomosis. Postoperative computed tomography angiography confirmed bypass patency. Collateral circulation through the thyrocervical and costocervical trunks likely supplied the left arm, and no cerebral, or limb, ischemic symptoms were noted on follow-up. VA-CCA transposition is an uncommon technique for safe and effective revascularization of symptomatic, medically refractory VBI caused by VA occlusion or, as in this case, SCA occlusion with secondary subclavian steal. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.

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