Brinjikji Waleed, Cloft Harry, Kallmes David F
Mayo Medical School, Mayo Clinic, Rochester, Minnesota 55906, USA.
Clin Anat. 2009 Apr;22(3):319-23. doi: 10.1002/ca.20785.
Lateral C1-C2 puncture is associated with a number of complications including damage of aberrant posterior inferior cerebellar arteries (PICA). We propose to determine the frequency of cases in which the PICA originates or descends below C1, thus posing a risk to the patient undergoing lateral C1-C2 puncture. Two hundred and eleven consecutive patients who received bilateral or unilateral vertebral angiography for evaluation of cerebrovascular lesions were included in this study. In total, 346 PICAs were studied. Lateral vertebral angiograms were analyzed for the location of the origin of the PICA and the inferior-most portion of the PICA relative to three anatomical regions. Region 1 was defined as the region above the foramen magnum. Region 2 was defined as the region below the foramen magnum but above the inferior border of the posterior arch of C1. Region 3 was defined as the region below the inferior border of the posterior arch of C1. In 2 of 346 angiograms (0.6%) and 2 of 211 patients (0.9%), the caudal loop of the PICA descended to Region 3. The PICA did not originate in Region 3 in any cases. In approximately 1% of patients in our study, the caudal loop of the PICA descended into a region that may have placed it at risk for damage during C1-C2 puncture. Our study suggests that it may be important for radiologists to assess the arterial anatomy of the C1-C2 region before performing C1-C2 puncture.
C1-C2外侧穿刺会引发多种并发症，包括损伤异常的小脑后下动脉（PICA）。我们旨在确定PICA起源于或下行至C1以下从而对接受C1-C2外侧穿刺的患者构成风险的病例发生率。本研究纳入了211例连续接受双侧或单侧椎动脉血管造影以评估脑血管病变的患者。总共研究了346条PICA。对椎动脉外侧血管造影进行分析，以确定PICA的起源位置以及PICA相对于三个解剖区域的最下端部分。区域1定义为枕骨大孔上方的区域。区域2定义为枕骨大孔下方但在C1后弓下缘上方的区域。区域3定义为C1后弓下缘下方的区域。在346例血管造影中的2例（0.6%）以及211例患者中的2例（0.9%）中，PICA的尾袢下行至区域3。在任何情况下，PICA均未起源于区域3。在我们研究的约1%的患者中，PICA的尾袢下行至一个在C1-C2穿刺过程中可能使其有受损风险的区域。我们的研究表明，放射科医生在进行C1-C2穿刺前评估C1-C2区域的动脉解剖结构可能很重要。
