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Journal of Neurosurgical Sciences 2003 December;47(4):183-7

Copyright © 2004 EDIZIONI MINERVA MEDICA

language: English

A vertebral artery tortuous course below the posterior arch of the atlas (without passing through the transverse foramen). Anatomical report and clinical significance

Jian F. Z. 1, 2, Santoro A. 2, Wang X. W. 1, Passacantili E. 2, Seferi A. 2, Liu S. S. 1

1 Department of Neurosurgery, Beijing Hospital, Beijing, China 2 Department of Neurological Sciences Division of Neurosurgery University of Rome “La Sapienza”, Rome, Italy


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A ver­te­bral ­artery (VA) cours­ing ­below the pos­te­ri­or ­arch of the ­atlas (C1) with­out pass­ing ­through the trans­verse fora­men of C1, com­bined ­with a tor­tu­ous ­course with­in the spi­nal ­canal has rare­ly ­been report­ed in the lit­er­a­ture. This arti­cle ­describes a ­case encoun­tered dur­ing an ana­tom­i­cal ­study of the far-lat­er­al ­approach, and ­reviews its embryon­ic devel­op­ment and clin­i­cal sig­nif­i­cance. The sub­oc­cip­i­tal tri­an­gle was ­filled ­with numer­ous ­venous plex­ures. After exit­ing ­from the trans­verse fora­men of C2, ­instead of pass­ing ­upwards ­through the trans­verse fora­men of C1, the VA ­turned direct­ly medi­al­ly ­towards the spi­nal ­canal. At the spi­nal ­canal, it ­first ­formed an ­angle down­wards, ­then ­turned ­upwards, pierc­ing and enter­ing the lat­er­al ­part of the ­dura at C1 lev­el. The diam­e­ter of ­this VA ­seemed to be with­in its nor­mal lim­its. The ­course of the con­tra­lat­er­al (­right) VA was nor­mal but ­with a ­small cal­i­ber and main­ly sup­plied the pos­te­ri­or infe­ri­or cer­e­bel­lar ­artery (­PICA); ­after ­PICA, it ­became ­much thin­ner and dys­plas­tic, the bas­i­lar ­artery was main­ly sup­plied by the ­left VA. The bilat­er­al pos­te­ri­or com­mu­ni­cat­ing arter­ies ­were ­large in diam­e­ter but ­there was dys­pla­sia of the P1 seg­ment of the pos­te­ri­or cere­bral arter­ies bilat­er­al­ly. Marked tor­tu­os­ity of the bilat­er­al intra­ca­ver­nous inter­nal carot­id ­artery (ICA) was ­also ­found. We did not ­find any ­osseous abnor­mal­ity in the occi­pi­to-­axial ­region or of C1-C2 ­joint. An abnor­mal ­course of the VA ­should be ­kept in ­mind dur­ing expo­sure of the cra­ni­o­cer­vi­cal junc­tion, espe­cial­ly in the varie­ty of lat­er­al approach­es; due to com­pres­sion of the ­nerve ­roots or the spi­nal ­cord, ­this abnor­mal ­course of the VA ­could ­give ­rise to clin­i­cal symp­toms, ­which ­could be ­resolved by micro­vas­cu­lar decom­pres­sion tech­nique.

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