Minimally invasive surgical treatment for Kimmerle anomaly

Abstract

Introduction:Kimmerle anomaly is the bony ridge between the lateral mass of atlas and its posterior arch or transverse process. This bony tunnel may include the V3 segment of the vertebral artery, vertebral vein, posterior branch of the C1 spinal nerve, and the sympathetic nerves, which results in the clinical symptoms of this disease. Reports on the surgical treatment of Kimmerle anomaly are rare. There are no reports on minimally invasive surgical treatment of this pathology.Materials and Methods:Six patients with Kimmerle anomaly were treated from 2015 until 2016. Three patients underwent routine surgery through the posterior midline (posterior midline approach [PMA] group). The other three patients underwent decompression with a paravertebral transmuscular approach (PTMA group). The operation time, intraoperative blood loss, clinical symptoms before and after surgery as well as intra- and post-operative complications were compared between the PTMA and PMA groups.Results:The results of the surgical treatments were assessed at discharge and 1 year later. Blood loss, operation time, and intensity of pain at the postoperative wound area were lower in the PTMA group. There were no postoperative complications. The delayed surgical treatment outcomes did not depend on the method of artery decompression.Conclusions:Surgical treatment of vertebral artery compression in patients with Kimmerle anomaly is preferable in cases where conservative treatment is inefficient. A minimally invasive PTMA is an alternative to the routine midline posterior approach, providing direct visualization of the compressed V3 segment of the vertebral artery and minimizing postoperative pain.

Torticollis, Facial Asymmetry, Local Pain, and Barré‐Liéou Syndrome in Connection with One‐Sided Ponticulus Posticus: A Case Report and Review of the Literature

“…However, recent studies about PP seem to focus on its association with headache and its implications during the placement of lateral mass screws in the atlas 17,20,21 . Until now, only six studies have described the surgical treatment of PP (Table 1) 3,5,[8][9][10][11] .…”

“…PP occurs at rates of 1.1%-37% according to different studies 2,3 . This bony canal usually includes the V3 segment of the vertebral artery (VA) and may also include the accompanying vein, sympathetic nerves, posterior C1 spinal nerve, and posterior branch of the C1 spinal nerve 5 . Therefore, compression or irritation of these structures by PP with spinal movement may lead to the clinical signs 5,6 .…”

“…The majority of the population with PP have no symptoms; clinical signs (including symptoms of vertebrobasilar insufficiency, migraine, cervicogenic headache, neck and shoulder pain, hearing loss, and Barré-Liéou syndrome) have been reported in only 5.5%-7% of PP patients 2,[7][8][9] . Until now, few studies have described the surgical treatment of PP, and the reported symptoms of these patients were mainly vertebrobasilar insufficiency symptoms and/or localized pain 3,5,[9][10][11] .…”

The Importance of Arcuate Foramen, A Variation of the Atlas: A Microsurgical Cadaveric Study and Review of the Literature

“…The fact that AF contains all these other neurovascular structures causes pressure on VA within the foramen. As a matter of fact, AF decompression is applied in these cases considering that VBI Clinic in Barre Lieou syndrome is formed by this mechanism (19,20). However, although clinical improvement was achieved in most of the cases with foramen decompression, 13.33% of young patients without cervical arthrosis also reported not to respond completely to treatment (19).…”

“…Cadaver studies are an important method in elucidating the ethiopathogenesis of diseases and determining the treatment. It is thought that AF causes Barre Lieou syndrome, which also includes vertebrobasilar insufficiency (VBI) findings, by compressing the structures within AF, therefore foramen decompression is performed in its treatment (19,20). However, only one study was found in the literature in English (18).…”