Vertebral Artery Transposition and Dural Ring Reconstruction: A New Treatment Modality for Cervical Spinal Cord Compression Resulting From Aberrant Vertebral Arteries

Abstract

BACKGROUND: Two of three patients who were consecutively treated within the past 7 years using traditional methods in our center presented with recurrence and even aggravation during follow-up. Therefore, a new approach was developed to treat a recent patient to provide for complete decompression of the spinal cord. OBJECTIVE: To illustrate a new treatment modality for patients with cervical spinal cord compression resulting from aberrant vertebral arteries. METHODS: The aberrant vertebral arteries were freed after substantial dissection of their dural rings. The compression was released after moving the aberrant vertebral arteries, which were sutured to the lateral mass to the extradural space. New dural rings above the atlas were created to allow the vertebral artery to enter the dura mater into a wider subdural space. RESULTS: The patient experienced full relief from her initial complaints except for mild numbness of the bilateral lower extremities immediately after surgery. Postoperative imaging studies indicated successful transposition of bilateral aberrant vertebral arteries and significant decompression of the spinal cord. Her symptoms did not recur over a 6-month follow-up period. Imaging studies at the 6-month follow-up showed stable vertebral artery transposition and spinal cord decompression. CONCLUSION: A patient with cervical spinal cord compression resulting from aberrant vertebral arteries was successfully treated by our new technique, which includes vertebral artery transposition, fixation, and dural ring reconstruction. Our approach could be an alternative for durable spinal cord decompression in such patients.