Prabhu V C, France J C, Voelker J L, Zoarski G H
Department of Neurosurgery, West Virginia University, PO Box 9183, Morgantown, WV 26506, USA.
Surg Neurol. 2001 Jan;55(1):29-33; discussion 33-4. doi: 10.1016/s0090-3019(00)00338-4.
Vertebral artery injury during posterior C1-2 transarticular screw fixation occurs in approximately 3% of patients and may remain asymptomatic or result in arteriovenous fistulae, occlusion, narrowing, or dissection of the vertebral artery, and lead to transient ischemic attacks, stroke, or death.
This is the first report of a pseudoaneurysm resulting from damage to the vertebral artery during the procedure. This 31-year-old male underwent posterior C1-2 transarticular screw fixation for unstable os odontoideum. Injury to the left vertebral artery occurred while the hole for the left screw was being drilled. Temporary control of bleeding with local pressure was followed by immediate postoperative angiography that revealed a left vertebral artery pseudoaneurysm. Although the patient remained asymptomatic, therapeutic anticoagulation was instituted 6 hours postoperatively. Increasing size of the pseudoaneurysm was noted on routine follow-up angiography 4 weeks later. Endovascular occlusion of the pseudoaneurysm and left vertebral artery, with preservation of vertebrobasilar flow through the right vertebral artery, was accomplished without neurological consequence.
Vertebral artery pseudoaneurysm complicating posterior C1-2 transarticular screw fixation may be effectively treated with endovascular approaches.
在C1 - 2后路经关节螺钉固定术中，椎动脉损伤发生率约为3%，可能无症状，也可能导致动静脉瘘、闭塞、狭窄或椎动脉夹层形成，进而引发短暂性脑缺血发作、中风或死亡。
本文首次报道了该手术过程中椎动脉损伤导致假性动脉瘤形成的病例。该31岁男性因不稳定型齿状突骨接受C1 - 2后路经关节螺钉固定术。在钻左侧螺钉孔时，左侧椎动脉受损。局部压迫暂时控制出血后，术后立即进行血管造影，显示左侧椎动脉假性动脉瘤。尽管患者无症状，但术后6小时开始进行治疗性抗凝。4周后的常规随访血管造影显示假性动脉瘤增大。通过血管内闭塞假性动脉瘤和左侧椎动脉，同时保留通过右侧椎动脉的椎基底动脉血流，手术未造成神经功能损害。
血管内治疗方法可有效治疗C1 - 2后路经关节螺钉固定术并发的椎动脉假性动脉瘤。
