Yamazaki Masashi, Okawa Akihiko, Aramomi Masa-aki, Hashimoto Mitsuhiro, Masaki Yutaka, Koda Masao
Department of Orthopaedic Surgery, Chiba University Graduate School of Medicine, Chuo-ku, Chiba, Japan.
Spine (Phila Pa 1976). 2004 Dec 1;29(23):E551-4. doi: 10.1097/01.brs.0000146454.24765.71.
Case report of a Down syndrome patient with right vertebral artery fenestration and abnormalities of the craniovertebral junction.
Describe the utility of 3-dimensional computed tomography angiography for evaluating vertebral artery anomalies before surgery.
Previous reviews evaluating catheter angiograms identified various anomalies of vertebral artery at the craniovertebral junction. The frequency of vertebral artery anomalies is increased in patients having osseous anomalies at the craniovertebral junction. Down syndrome is associated with a high incidence of bone abnormalities at the craniovertebral junction, but there have been no published reports of vertebral artery anomalies per se at the craniovertebral junction.
A 16-year-old woman with trisomy 21 presented with gait abnormalities and myelopathy in association with bone abnormalities at the craniovertebral junction, including hypoplastic odontoid and ossiculum terminale. Computed tomography angiography showed that right vertebral artery bifurcated after exiting the C2 transverse foramen with one branch passing through the C1 transverse foramen, whereas the other turned posteromedially and entered the spinal canal between C1 and C2.
Occipito-C2 posterior fusion was performed with a rod and screw system. Intraoperatively, the course of the anomalous right vertebral artery was identified by Doppler angiography, and the surgical approach was modified to allow safe pedicle screw insertion while avoiding vertebral artery injury. After surgery, myelopathy resolved within 3 months.
Before corrective surgery of craniovertebral junction anomalies in patients with Down syndrome, the possibility of vertebral artery anomalies associated with abnormal craniovertebral junction anatomy should be considered. With preoperative 3-dimensional computed tomography angiography, we can precisely identify the anomalous vertebral artery and modify the surgical approach to reduce the possible risk of intraoperative vertebral artery injury in advance.
一名患有唐氏综合征且伴有右椎动脉开窗及颅颈交界区异常的患者的病例报告。
描述三维计算机断层血管造影在术前评估椎动脉异常中的应用。
既往对导管血管造影的综述确定了颅颈交界区椎动脉的各种异常情况。颅颈交界区存在骨异常的患者中椎动脉异常的发生率增加。唐氏综合征与颅颈交界区骨异常的高发生率相关，但尚无关于颅颈交界区椎动脉异常本身的发表报告。
一名16岁的21三体综合征女性患者，出现步态异常和脊髓病，伴有颅颈交界区的骨异常，包括齿状突发育不全和终末小骨。计算机断层血管造影显示，右椎动脉在离开C2横突孔后分叉，一支穿过C1横突孔，另一支向后内侧转向并进入C1和C2之间的椎管。
采用棒和螺钉系统进行枕颈C2后路融合术。术中，通过多普勒血管造影确定异常右椎动脉的走行，并修改手术入路，以在避免椎动脉损伤的同时安全地插入椎弓根螺钉。术后，脊髓病在3个月内得到缓解。
在对唐氏综合征患者的颅颈交界区异常进行矫正手术前，应考虑与颅颈交界区解剖结构异常相关的椎动脉异常的可能性。通过术前三维计算机断层血管造影，我们可以精确识别异常椎动脉，并提前修改手术入路，以降低术中椎动脉损伤的可能风险。
