Spine Center, Department of Orthopaedic Surgery, Teine Keijinkai Hospital, Sapporo, Japan.
Spine Center, Department of Orthopaedic Surgery, Teine Keijinkai Hospital, Sapporo, Japan.
World Neurosurg. 2020 Nov;143:e535-e540. doi: 10.1016/j.wneu.2020.08.003. Epub 2020 Aug 8.
Unilateral vertebral artery (VA) injury is thought to not result in serious complications. The dominant-side VA should be preserved, although the importance of the nondominant-side VA has not been discussed. The injury of VA terminating posterior inferior cerebellar artery (PICA-VA) may result in cerebellar infarction. The characteristics of PICA-VA were evaluated.
In study 1, results of head and neck magnetic resonance angiography were reviewed for 358 consecutive cases. VA diameter was measured at the V2 segment. Relationships between frequency of PICA-VA and asymmetry and diameter of the VA were analyzed. In study 2, results of magnetic resonance angiography were measured for 62 consecutive cases aged ≤39 years. Frequency of PICA-VA was compared between this young age group and 324 of the 358 cases aged ≥50 years.
Mean age for the total cohort was 67.8 ± 13.8 years (range, 10-94 years). PICA-VA was identified in 44 cases (12.3%). Mean diameter of all VAs was 3.2 ± 0.76 mm. Mean diameter of PICA-VA was 2.0 ± 0.55 mm, significantly smaller than the nondominant side in Confluence (+) (2.8 ± 0.59 mm; P < 0.001). Among the 56 VAs <2.0 mm, 26 (46.4%) were PICA-VA. PICA-VA was seen in 1 of the 62 cases aged ≤39 years (1.6%), and in 43 of the 324 cases aged ≥50 years (13.3%), showing a significantly lower frequency in the younger population (P < 0.001).
Whether PICA-VA injury causes complications is not obvious. However, PICA-VA should also be preserved considering that potential risks exist. If the VA is small or shows a large difference in diameter between sides, special care should be taken during cervical spine surgery.
单侧椎动脉（VA）损伤被认为不会导致严重并发症。尽管尚未讨论非优势侧 VA 的重要性，但应保留优势侧 VA。椎动脉终末后下小脑动脉（PICA-VA）损伤可能导致小脑梗死。评估了 PICA-VA 的特征。
在研究 1 中，回顾了 358 例连续病例的头颈部磁共振血管造影结果。测量了 V2 节段的 VA 直径。分析了 PICA-VA 的发生率与 VA 不对称和直径之间的关系。在研究 2 中，对 62 例年龄≤39 岁的连续病例的磁共振血管造影结果进行了测量。比较了该年轻组与 358 例≥50 岁病例之间 PICA-VA 的发生率。
总队列的平均年龄为 67.8 ± 13.8 岁（范围 10-94 岁）。44 例（12.3%）存在 PICA-VA。所有 VA 的平均直径为 3.2 ± 0.76mm。PICA-VA 的平均直径为 2.0 ± 0.55mm，明显小于 Confluence（+）侧的非优势侧（2.8 ± 0.59mm；P<0.001）。在 56 条直径<2.0mm 的 VA 中，有 26 条（46.4%）为 PICA-VA。在 62 例年龄≤39 岁的患者中，有 1 例（1.6%）存在 PICA-VA，而在 324 例年龄≥50 岁的患者中，有 43 例（13.3%）存在 PICA-VA，年轻人群的发生率明显较低（P<0.001）。
尽管 PICA-VA 损伤是否会引起并发症尚不明显，但考虑到存在潜在风险，也应保留 PICA-VA。如果 VA 较小或两侧直径差异较大，则在进行颈椎手术时应特别小心。
