Fenestration of the Extracranial Vertebral Artery

Sim, Ernst; Vaccaro, Alexander R.; Berzlanovich, Andrea; Thaler, H; Ullrich, Christopher G.

doi:10.1097/00007632-200103150-00007

Cited by 48 publications

(45 citation statements)

References 7 publications

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“…Fenestration differs from duplication in that the artery has a single origin and then separates into two parallel arteries along the length of its course [1]. Fenestrations of the extracranial course of the vertebral arteries are rare and are usually noted incidentally during angiographic studies or post mortem examinations [2]. Some authors have suggested that fenestration of vertebral arteries is a congenital abnormality without pathological significance [2].…”

Section: Introductionmentioning

confidence: 99%

“…Fenestrations of the extracranial course of the vertebral arteries are rare and are usually noted incidentally during angiographic studies or post mortem examinations [2]. Some authors have suggested that fenestration of vertebral arteries is a congenital abnormality without pathological significance [2]. Arterial dissection and thromboembolism can arise within fenestrated vessels, and shearing forces induced by vigorous head movement may be responsible [3].…”

Section: Introductionmentioning

confidence: 99%

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An 18-year-old man with fenestrated vertebral arteries, recurrent stroke and successful angiographic coiling

Bernard

Mull

Handler

et al. 2007

Journal of the Neurological Sciences

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Fenestration of vertebral arteries has been reported in association with thromboembolic brain infarctions. However, few cases have been reported in which recurrent infarction occurred in spite of adequate anticoagulation. We report a young man with fenestrated vertebral arteries and stroke who failed to respond to standard anticoagulation therapy but did well with angiographic coil obliteration of an abnormal vertebral segment. An 18-year-old left-handed man presented with acute onset of dizziness and headache. No trauma or other stroke risk factors were identified. Left cerebellar infarction was seen on CT, but the cause could not be identified by brain and neck MRI, MRA, or CTA. Bilateral fenestrated vertebral arteries were identified with conventional angiography. Although the patient recovered fully and was treated with anticoagulation, he suffered a recurrent stroke 1 month later involving the right cerebellum while he was on a therapeutic dose of warfarin. Repeat arteriography showed a spontaneous dissection within one of the fenestrated vertebral segments. Since receiving angiographic coil obliteration of the pathologic segment, he has been free of all symptoms. We conclude that the patient sustained recurrent thromboembolic events in his posterior circulation due to spontaneous dissection within a fenestrated vertebral artery segment. Conventional angiography and emergent interventional embolization were essential to his diagnostic evaluation and therapeutic intervention.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

An 18-year-old man with fenestrated vertebral arteries, recurrent stroke and successful angiographic coiling

Bernard

Mull

Handler

et al. 2007

Journal of the Neurological Sciences

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“…9 Sim et al described that sometimes there occurs failure of the controlled regression of this portion of the primitive dorsal aorta along with the two inter segmental arteries which leads to the double origin and duplication of the vertebral arteries. 10 The bilateral occurrence of these failures is the reason behind the bilateral duplication of the vertebral arteries. The vertebral vessels are responsible for the formation of the transverse foramen.…”

Section: Discussionmentioning

confidence: 99%

Clinical significance of presence of accessory foramen transversarium in typical cervical vertebrae

Esakkiammal

Chauhan

2016

Int J Res Med Sci

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INTRODUCTIONThe foramen transversarium (FT) is a typical feature of cervical vertebrae. Both typical and atypical cervical vertebrae have FT. The presence of FT differentiates cervical vertebrae from other vertebrae. The FT of 6 th to 1 st cervical vertebrae transmits the 2 nd part of the vertebral artery, vertebral veins, and sympathetic nerves from inferior cervical ganglion.1 Presence of another foramen apart from FT in the transverse process of cervical vertebrae is called accessory FT which is smaller in size than the primary foramen. Generally, it is found in the sixth cervical vertebra and less frequently in other typical cervical and 7 th cervical vertebrae. 2 This accessory FT lies posterior to the normal FT. Any variation in the FT may affect the course of vertebral artery and may cause serious complications like vertebrobasilar insufficiency.3 Under such circumstances, the course of ABSTRACT Background: The cervical vertebrae are smallest of all the vertebrae present in the vertebral column. It is characterized by a foramen in each transverse process. The foramen transversarium (FT) of 6 th to 1 st cervical vertebrae transmits vertebral vessels and sympathetic nerves. Presence of another foramen apart from FT in the transverse process of cervical vertebrae is called accessory FT. Anatomical knowledge of these variations are helpful for conducting cervical spinal surgeries by the surgeons in order to prevent injury to vertebral vessels and sympathetic nerves. Methods: The present study was conducted in the department of anatomy, UCMS and GTB Hospital, Delhi, India. A total number of 241 dried cervical vertebrae were collected from the bone bank of the Department of Anatomy. Presence of any variation from the normal anatomy of the cervical vertebrae were noted and photographed. Results: Out of 241 cervical vertebrae (typical and atypical), the accessory FT was noted in typical cervical vertebrae only. Accessory FT was seen in 37 (27.6%) vertebrae, out of 134 typical cervical vertebrae. These accessory FT were either bilateral complete in 4 (2.9%) or incomplete 9 (6.7%) or unilateral complete 6 (4.5%) and unilateral incomplete 12 (8.9%) were observed. Six (4.5%) typical cervical vertebrae showed presence of complete accessory FT on one side and incomplete accessory FT on the other side in the same vertebra. Conclusions: Knowledge of variations of the presence of accessory FT in the typical cervical vertebrae is not only important to anatomist but also to radiologist in identifying the presence of duplicate vertebral artery and hence helping the neuro surgeons in preventing accidental bleeding from the vertebral artery while performing surgery on the cervical spine.

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“…The variation of the basilar artery dilation and fenestration is common. Sim et al [4] pointed out that this kind of variation was only random, non-symptomatic, was not clinically relevant. However, Miyazaki et al [5] believed that there might be some correlation between the basilar artery fenestration with multiple intracranial aneurysms.…”

Section: Commentarymentioning

confidence: 99%

Arterial Vascular Variation of the Head and Neck and Its Clinical Significance

Shi¹

2017

J Neurol Neurophysiol

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CommentaryArterial vascular variation of the head and neck is common and is often overlooked because of the lack of obvious clinical symptoms. Variations are generally detected accidentally by head and neck computed tomography angiography (CTA), magnetic resonance angiography (MRA) or ultrasound. Considering the lack of adequate understanding of the presence and location of the arterial vascular variations of the head and neck, vessels are easily injured or incorrectly ligated intraoperatively. Sometimes this could even cause fatal consequences. Therefore, in recent years, increasing attention has been paid to the diagnosis and assessment of arterial vascular variations of the head and neck.As an important part of the brain's blood supply system, there are many types of variations in the vertebral artery. Common variations of vertebral arteries mainly include variations in origin, in number, in the first transverse foramen during the ascending process, and in diameter, amongst others. A variation in origin refers to the origin of a vertebral artery from an artery other than the subclavian artery. A left vertebral artery originating from the aortic arch between the left common carotid artery (CCA) and the left subclavian artery is the most common variation in the origin of the vertebral artery. Although the blood supply is not majorly affected, the vertebral artery blood pressure often increases significantly. This can lead to vertebral artery atherosclerosis, stenosis or obstruction. Increased pressure within the aortic arch further becomes one of the prime reasons for rupture or formation of arterial dissection of the left vertebral artery. A vertebral artery originating from the CCA is rare; however, researchers have found that the aberrant right subclavian artery and origin variation of the right vertebral artery have a certain correlation [1]. A vertebral artery of anomalous origin often leads through the first transverse foramen higher than the normal origin, leading to the initial segment of the vertebral artery being extensive and tortuous and a lack of protection of the cervical transverse process. Rotation of the neck may cause vertebral artery spasms or dissection and even occlusion [2]. The vertebral artery of anomalous origin generally leads through the fifth, the fourth, or even the seventh vertebra other than the sixth vertebra. The neurosurgeon should completely understand and evaluate the presence of vertebral artery variations to avoid damage to the vertebral artery and the blood supply to the spinal cord and brain during surgery. A variation in number of vertebral arteries means unilateral or bilateral absence of vertebral artery or the increase of the number of vertebral arteries. Hypoplasia of vertebral artery is common. Vertebral artery hypoplasia refers to that the diameter of vertebral artery is less than 2.5 mm or the diameter of one side vertebral artery is less than 50% of the contralateral side. But the diagnostic criteria of vertebral artery hypoplasia are not uniform. Chaturvedi et a...

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Fenestration of the Extracranial Vertebral Artery

Abstract: Fenestration of the extracranial course of the vertebral artery is a developmental or congenital anomaly. A review of the literature demonstrated that this is apparently only a coincidental finding and has no pathologic significance.

Cited by 48 publications

References 7 publications

An 18-year-old man with fenestrated vertebral arteries, recurrent stroke and successful angiographic coiling

An 18-year-old man with fenestrated vertebral arteries, recurrent stroke and successful angiographic coiling

Clinical significance of presence of accessory foramen transversarium in typical cervical vertebrae

Arterial Vascular Variation of the Head and Neck and Its Clinical Significance

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