Normal anatomical variations of the V3 segment of the vertebral artery: surgical implications

Ulm, Arthur J.; Quiroga, Mónica; Russo, Antonino; Russo, Vittorio; Graziano, Francesca; Velasquez, Angel; Albanese, Erminia

doi:10.3171/2010.4.spine09824

Cited by 44 publications

(46 citation statements)

References 32 publications

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“…With the development of new technologies such as navigated procedures, anatomical references will seem less useful, however the availability of these resources is not feasible in most centers in developing countries. In addition, there are publications that show that neuro-navigated procedures have not yet surpassed free-hand procedures in safety and risk of complications (Ulm et al;Alfaouri-Kornieieva & Al-Hadidi, 2014;Ha et al, 2014). Anatomical understanding of this region will continue to be relevant for neurosurgeons, especially for those who encounter a rising learning curve.…”

Section: Discussionmentioning

confidence: 99%

“…Vertebral artery injury has been reported in spinal surgery in 5.4 % in laminectomies, 11.7 % in posterior region exposure, and 32.4 % in C1-C2 spine fixation, from this 9.5 % in C1-C2 transarticular screws and 8 % in pedicle screws (Khan et al, 2007;Yamaguchi et al, 2008;Lunardini et al;Shafafy et al, 2017;Hlubek et al, 2018). These may have neurologic repercussion in 0.2 -14.25 % of cases (Fassett et al;Ulm et al, 2010). Injuries include not only bleeding, but also complications, such as pseudoaneurysm, arteriovenous fistula, vertebrobasilar insufficiency, posterior fossa infarction, and even death of the patient (Fassett et al; Shafafy et al).…”

Section: Introductionmentioning

confidence: 99%

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Safety Ranges in V3 Segment of the Vertebral Artery for Surgical Procedures at the Craniocervical Junction

Cruz-Elizondo¹,

Villarreal-Silva²,

Quiroga‐Garza³

et al. 2020

Int. J. Morphol.

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The aim of this study was to establish safety ranges for the third vertebral artery segment (V3) for craneocervical procedures. Injury to V3 represents a potentially catastrophic complication. Its tortuous path and complex relationship with neighboring structures, increasing the risk. Ten male adult cadavers (20 vertebral arteries) with arterial infiltration of red latex were studied. The length, angles and anatomical measurements were obtained between the selected surgical landmarks and the portions of V3 segment. The horizontal portion has a length of 32.7 ± 3.6 mm with an angulation of 115.1 ± 8.3 degrees. The mean distances of the horizontal portion were: from the midline to the V3 groove of C1 posterior arch (24.7 ± 6.3 mm); from C1 pars interarticularis to the V3 distal loop of V3 (8.9 ± 1.4 mm). The vertical portion has a length 32.5 ± 5.6 mm with an angulation of the proximal loop of 113.6 ± 5.8 degrees. The mean distances between the C2 spinous process to the medial surface of the distal loop (43.8 ± 4.2 mm); from the C1-C2 joint to the V3 vertical portion (9.5 ± 1.5 mm); from C2 pars interarticularis to V3 in the C2 transverse foramen (6.5 ± 3.4 mm); from C2 pars interarticularis to V3 in the C1 transverse foramen (17.5 ± 4.5 mm). We reported four potential sites where V3 can be injured during four different surgical procedures: exposure of the posterior arch of C1, and pars interarticularis of C1 in the horizontal portion and exposure of the C1-C2 joint, and placement of C1-C2 transarticular screws one in the vertical portion. We provide measurements of redundancy and safety ranges to reduce the risk of injury to the V3 segment during craniocervical surgical procedures.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Safety Ranges in V3 Segment of the Vertebral Artery for Surgical Procedures at the Craniocervical Junction

Cruz-Elizondo¹,

Villarreal-Silva²,

Quiroga‐Garza³

et al. 2020

Int. J. Morphol.

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“…Their discovery is, however, more frequently accidental during surgical procedures in the cervical spine and cranio-cervical junction, where they increase the risk of peri-operative complications (6). They are purposefully investigated when a hemodynamic signifi cance is presumed.…”

Section: Anatomical Considerationsmentioning

confidence: 99%

Transient ischemic attack in the vertebro-basilar circulation due to a hemodynamically significant variation – kinking of the extracranial section of the left vertebral artery

Wagnerova¹,

Goldenberg²

2013

BLL

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Abstract:We present a case report of a 74-year old female patient with the clinical diagnosis of transient ischemic attack (TIA) in the vertebro-basilar (VB) circulation, in whom we found bilateral variation of the extracranial section of vertebral arteries on ultrasound, on the left side to the extent of kinking. This fi nding was later confi rmed by magnetic resonance angiography (MRA). We discuss the presumed hemodynamic signifi cance of this variation and its etiological relation to the patient's clinical picture. Ultrasound examination of the carotid and vertebro-basilar circulations is an important examination technique contributing to an early detection of possible aetiology of the cerebral circulation disorders (Fig. 7 A transient ischemic attack (TIA) is an acute episode of neurological dysfunction resulting from focal cerebral ischemia not associated with permanent cerebral infarction. A group of cerebrovascular experts proposed a shift from the arbitrary time-based defi nition of TIA to a tissue-based defi nition in 2002 with a new defi nition for TIA as "a brief episode of neurological dysfunction caused by focal brain or retinal ischemia, with clinical symptoms typically lasting less than one hour, and without evidence of an acute infarction". (1) This proposed new defi nition was well received and endorsed by many clinicians. The American Heart Association and American Stroke Association (AHA/ASA) 2009 Guidelines endorsed this new defi nition, modifying it with the omission of the phrase "typically less than one hour," as there is no time cut-off that reliably distinguishes whether a symptomatic ischemic event will result in tissue infarction. The AHA/ASAendorsed defi nition of TIA is following: Transient ischemic attack (TIA) is a transient episode of neurological dysfunction caused by focal brain, spinal cord, or retinal ischemia, without an acute infarction (2).TIA in the vertebro-basilar (VB) circulation is characterized by vertigo, nausea, vomiting, double vision, ataxia, dysarthria, dysphagia and bilateral or alternating disturbances of movement or sensory functions. An isolated vertigo may be the initial symptom; however, a combination of symptoms is more typical (3).Atherosclerosis of the major vessels has been the cause of TIA in the VB circulation in 31 % of patients, followed by embolism from the heart (27 %), intra-arterial embolism (17 %), affection of the smaller vessels (16 %), and a number of more uncommon causes (9 %). Stenotic changes in the VB circulation may cause the symptom onset by a hemodynamic mechanism; frequently there are short, stereotypic, and predominantly orthostatic TIAs. Compression or stretching of the vertebral arteries due to the degenerative changes in the cervical spine, depending on position of the head, may also result in perfusion disturbances; retrofl ection, rotation, and their combination in particular, are of the highest risk (4). The ischemia often manifests itself at rest and early in the morning, when there usually is a physiological lowering of the ...

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“…And finally, the fourth arterial segment (V 4 ) is the intradural portion from the foramen magnum until the two VAs merge to form the basilar artery. Essentially, V 1 is at the transition from the thorax to the neck, V 2 and V 3 course through the neck (and are therefore the most vulnerable to trauma) and V 4 is the final portion of the artery within the skull before it merges to form the basilar artery [1, 2]. …”

Section: Introductionmentioning

confidence: 99%

The perivascular environment along the vertebral artery governs segment-specific structural and mechanical properties

et al. 2016

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The vertebral arteries (VAs) are anatomically divided into four segments (V1–V4), which cumulatively transport blood flow through neck and ultimately form the posterior circulation of the brain. The vital physiological function of these conduit vessels depends on their geometry, composition and mechanical properties, all of which may vary among the defined arterial segments. Despite their significant role in blood circulation and susceptibility to injury, few studies have focused on characterizing the mechanical properties of VAs, and none have investigated the potential for segmental variation that could arise due to distinct perivascular environments. In this study, we compare the passive mechanical response of the central, juxtaposed arterial segments of porcine VAs (V2 and V3) via inflation-extension mechanical testing. Obtained experimental data and histological measures of arterial wall composition were used to adjust parameters of structure-motivated constitutive models that quantify the passive mechanical properties of each arterial segment and enable prediction of wall stress distributions under physiologic loads and boundary conditions. Our findings reveal significant segmental differences in the arterial wall geometry and structure. Nevertheless, similar wall stress distributions are predicted in these neighboring arterial segments if calculations account for their specific perivascular environments. These findings allow speculation that segmental differences in wall structure and geometry are a consequence of a previously introduced principle of optimal operation of arteries, which ensures effective bearing of physiological load and a favorable mechanical environment for mechanosensitive vascular smooth muscle cells.

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Normal anatomical variations of the V3 segment of the vertebral artery: surgical implications

Cited by 44 publications

References 32 publications

Safety Ranges in V3 Segment of the Vertebral Artery for Surgical Procedures at the Craniocervical Junction

Safety Ranges in V3 Segment of the Vertebral Artery for Surgical Procedures at the Craniocervical Junction

Transient ischemic attack in the vertebro-basilar circulation due to a hemodynamically significant variation – kinking of the extracranial section of the left vertebral artery

The perivascular environment along the vertebral artery governs segment-specific structural and mechanical properties

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