Importance of preoperative detection of vertebral artery anomalies in neck surgery

Vaiman, Michael; Beckerman, Inessa

doi:10.1111/j.1445-2197.2010.05579.x

Cited by 9 publications

(9 citation statements)

References 12 publications

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“…Understanding the morphology of the aortic arch and its branches is important for planning surgical or endovascular procedures. 1,2 The development of computed tomography (CT) has enabled investigation of the prevalence of aortic arch branching patterns and types of arches in a large sample of living humans. Several large series of CT-based studies have established the prevalence of aortic arch variations in Germany, the United States, the United Kingdom, Turkey, and Serbia.…”

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confidence: 99%

Morphologic features of the aortic arch and its branches in the adult Chinese population

Wang

Zhang

Xin

2016

Journal of Vascular Surgery

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confidence: 99%

Morphologic features of the aortic arch and its branches in the adult Chinese population

Wang

Zhang

Xin

2016

Journal of Vascular Surgery

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“…In the course of reviewing papers, we found an interesting issue that there were some differences in the rate of variation of vertebral artery inlet in various reports. The variability of anomalous entry level we found was 8.30%, compared to 12.5% in Republika Srpska 5 , 15.7% in Germany 6 , 5.75% in Isreal 7 , 7.0% of LV and 6.2% of RV in Japan 8 , 8.7% in Taiwan, R.O.C 9 , 5.3% of LV and 0.8% of RV in Thailand 10 , 5.1% in Korea 11 , 8%of LV and 6.6% of RV in another study of Korea 12 , 7.5% of LV in Turkey 13 . This could be explained by sample sizes and structure differences.…”

Section: Discussionmentioning

confidence: 53%

Entrance and origin of the extracranial vertebral artery found on computed tomography angiography

Xie

Zhang

et al. 2022

Sci Rep

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To investigated morphological variability of vertebral artery (VA) origin and its entrance level into cervical transverse foramina by computed tomography angiography (CTA). To retrospectively investigated CTA of 223 subjects (446 VA courses). Investigated were origin of the VA and its level of entrance into vertebral transverse foramen with notification of the sex and side of variation. The VA entered the C6 transverse process in 91.70% of specimens (409 out of 446 VA courses). Abnormal entrance of VA was observed in 8.30% of specimens (37 VA courses), with the level of entrance into the C3, C4, C5, or C7 transverse foramen at 0.22%, 2.47%, 4.71% and 0.90% respectively. Comparably, the overall variability of abnormal origin of VA was 1.57% (7 out of 466 VA courses), in which the left vertebral arteries all arose from aortic arch. The variation rate of vertebral entrance rose up to 50% in abnormal origin subgroup. When comparing subgroups of subjects with normal and abnormal origin, there was significance difference in the frequency of entrance variation in the level of transverse foramen (p < 0.001). Abnormal entrance and origin of VA were observed in 8.30% and 1.57% of VA courses, which can be accurately appeared by CTA. Regarding to the subgroups of abnormal origin, the frequency of entrance variation was significantly increased in the level of transverse foramen compared to that of normal origin.

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“…If reported data of hypoplasia or dominance were split into V1 and V2 segments, they were summed up, so the prevalence of hypoplastic/dominant VA was calculated as a whole for the mentioned segments. Vaiman et al [ 18 ] analyzed a total of 400 VAs, with 23 anomalous VAs. We used 23 as the total number of vessels to determine the prevalences, since the article reported data about the origin and TF entrance only for these anomalous VAs.…”

Section: Methodsmentioning

confidence: 99%

The Vertebral Artery: A Systematic Review and a Meta-Analysis of the Current Literature

2023

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(1) Background. The anatomical variations of the vertebral arteries (VAs) have a significant impact both in neurosurgery and forensic pathology. The purpose of this study was to evaluate the variational anatomy of the vertebral artery. We evaluated anatomical aspects regarding the V1 and V2 segments of the VA: origin, course, tortuosity, hypoplasia, and dominance, and established the prevalence of each variation. (2) Methods. We conducted a systematic search in PubMed and Google Scholar databases, up to December 2022. Sixty-two studies, comprising 32,153 vessels, were included in the current meta-analysis. We used a random-effects model with a DerSimonian-Laird estimator. The confidence intervals were set at 95%. The heterogeneity between studies was assessed using I2. The funnel plot and Egger’s regression test for plot asymmetry were used for the evaluation of publication bias. Statistical significance was considered at p < 0.05. (3) Results. The most common site for the origin of both VAs was the subclavian artery. The aortic arch origin of the left VA had a prevalence of 4.81%. Other origins of the right VAs were noted: aortic arch (0.1%), right common carotid artery (0.1%), and brachiocephalic trunk (0.5%). Ninety-two percent of the VAs entered the transverse foramen (TF) of the C6 vertebra, followed by C5, C7, C4, and least frequently, C3 (0.1%). Roughly one out of four (25.9%) VAs presented a sort of tortuosity, the transversal one representing the most common variant. Hypoplasia occurred in 7.94% of the vessels. Left VA dominance (36.1%) is more common, compared to right VA dominance (25.3%). (4) Conclusions. The anatomy of the VA is highly irregular, and eventual intraoperative complications may be life-threatening. The prevalence of VA origin from the subclavian artery is 94.1%, 92.0% of the VAs entered the TF at C6, 26.6% were tortuous, and 7.94% were hypoplastic.

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Importance of preoperative detection of vertebral artery anomalies in neck surgery

Abstract: In planning neck or spinal surgery, the surgeon should bear in mind that VA anomalies are present in approximately 5.5-6.5% of cases. Preoperative 3D CT allows precise identification of anomalous VAs, thereby reducing the possible risk of intraoperative injury.

Cited by 9 publications

References 12 publications

Morphologic features of the aortic arch and its branches in the adult Chinese population

Morphologic features of the aortic arch and its branches in the adult Chinese population

Entrance and origin of the extracranial vertebral artery found on computed tomography angiography

The Vertebral Artery: A Systematic Review and a Meta-Analysis of the Current Literature

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