Lo William B, Nagaraja Sanjoy, Saxena Amar
Department of Neurosurgery, University Hospital, Coventry, United Kingdom.
Department of Neuroradiology, University Hospital, Coventry, United Kingdom.
World Neurosurg. 2017 Mar;99:811.e11-811.e18. doi: 10.1016/j.wneu.2016.12.084. Epub 2016 Dec 29.
Anterior cervical discectomy (ACD) is one of the most common spinal surgeries. Although rare, iatrogenic vertebral artery injuries (VAIs) are potentially life-threatening. Risk factors are anatomic, operative, and pathologic. We report a rare case of iatrogenic VAI during ACD and successful endovascular treatment with no long-term complications. We also review the literature on all VAIs associated with ACD and fusions. Risk factors and the safety and effectiveness of various management modalities are discussed.
A 64-year-old patient sustained iatrogenic right VAI during ACD, followed by the delayed formation of a vertebral artery pseudoaneurysm and subsequent rehemorrhage. The patient recovered well with no long-term neurologic sequelae. This case is unusual because the pseudoaneurysm was not apparent on early computed tomography angiography. There is currently no consensus regarding the appropriate intraoperative management for iatrogenic VAIs. Described treatment modalities include direct repair, tamponade, and endovascular procedures.
Delayed pseudoaneurysm formation after iatrogenic VAI can occur. Endovascular embolization can be a safe treatment alternative to surgical repair.
颈椎前路椎间盘切除术（ACD）是最常见的脊柱手术之一。虽然医源性椎动脉损伤（VAI）罕见，但有潜在生命危险。风险因素包括解剖、手术和病理因素。我们报告1例ACD术中罕见的医源性VAI病例及成功的血管内治疗，且无长期并发症。我们还回顾了与ACD和融合术相关的所有VAI的文献。讨论了风险因素以及各种治疗方式的安全性和有效性。
一名64岁患者在ACD术中发生医源性右侧VAI，随后形成椎动脉假性动脉瘤并延迟再出血。患者恢复良好，无长期神经后遗症。该病例不同寻常之处在于早期计算机断层血管造影未显示假性动脉瘤。目前对于医源性VAI的术中适当处理尚无共识。描述的治疗方式包括直接修复、填塞和血管内手术。
医源性VAI后可发生延迟性假性动脉瘤形成。血管内栓塞可以是手术修复的一种安全治疗替代方法。
