Department of Neurosurgery, College of Medicine, Soonchunhyang University, 22 Daesagwan-gil, Yongsan-gu, Seoul 140-743, South Korea.
Eur Spine J. 2012 Dec;21(12):2475-85. doi: 10.1007/s00586-012-2423-8. Epub 2012 Jul 12.
Anterior cervical spine operations (ACSO) are generally considered to be safe and effective, but the vertebral artery (VA) is at risk during the procedure. Because the consequences of VA injury can be catastrophic, properly managing a VA injury is very important. However, due to the rarity of these injuries, there is no agreed upon treatment strategy.
Studies were identified for inclusion in the review via sensitive searches of electronic databases through 31 December 2011. All cases included in the review were qualitatively analyzed to explore the relationship between type of VA injury management and neurological complications.
Seventeen articles describing 39 cases of VA injury during ACSO were included in this study. Seven patients (17.9 %) had neurological complications followed by VA insufficiency. Two patients (5.1 %) had root damage due to ligation. One case (2.6 %) resulted in intraoperative death due to fatal bleeding. Delayed vascular complications were identified in nine (45.0 %) of the 20 patients that underwent only tamponade or hemostatic agent during the operation. Four patients underwent intraoperative endovascular treatment, and three of these patients had a cerebral infarction. All three patients who underwent clipping also had neurological complications. The five patients treated by direct repair did not have any complications.
Our review suggests the management of VA injury should be considered in order listed: (1) performing tamponade with a hemostatic agent, (2) direct repair, (3) postoperative endovascular procedures to prevent delayed complications. If tamponade fails to achieve proper hemostasis, additional procedures as endovascular embolization, clipping and ligation should be considered but carry the risk of neurological complications. Because of the limitations of this review, further studies are recommended with larger sample sizes.
颈椎前路手术（ACSO）通常被认为是安全有效的，但在手术过程中椎动脉（VA）存在风险。由于 VA 损伤的后果可能是灾难性的，因此妥善处理 VA 损伤非常重要。然而，由于这些损伤的罕见性，目前还没有达成共识的治疗策略。
通过对截至 2011 年 12 月 31 日的电子数据库进行敏感搜索，确定了纳入本综述的研究。对纳入综述的所有病例进行定性分析，以探讨 VA 损伤管理类型与神经并发症之间的关系。
本研究共纳入了 17 篇描述 ACSO 期间 VA 损伤的 39 例病例的文章。7 例（17.9%）患者发生神经并发症，其次是 VA 不足。2 例（5.1%）因结扎导致神经根损伤。1 例（2.6%）患者因术中致命性出血导致术中死亡。20 例仅在术中使用填塞或止血剂的患者中，有 9 例（45.0%）出现延迟性血管并发症。4 例患者接受了术中血管内治疗，其中 3 例发生脑梗死。所有接受夹闭的 3 例患者也均出现神经并发症。5 例接受直接修复的患者均无并发症。
我们的综述表明，VA 损伤的处理应按以下顺序考虑：（1）用止血剂进行填塞，（2）直接修复，（3）术后血管内治疗以预防延迟性并发症。如果填塞未能达到适当的止血效果，则应考虑额外的血管内栓塞、夹闭和结扎等程序，但这些程序会带来神经并发症的风险。由于本综述的局限性，建议进行更大样本量的进一步研究。
