Goel Atul, Prasad Apurva, Shah Abhidha, Sasane Sumeet, Hawaldar Akshay, Biswas Chandrima, Thomas Antony
Department of Neurosurgery, K.E.M. Hospital and Seth G.S. Medical College, Mumbai, India.
Department of Neurosurgery, Lilavati Hospital and Research Centre, Mumbai, India.
Oper Neurosurg. 2021 Mar 15;20(4):E322-E325. doi: 10.1093/ons/opaa456.
The article identifies the feasibility of transarticular screw fixation after mobilizing the vertebral artery in cases where it is in a "high-riding" location.
A 42-yr-old male patient had a 4-yr history of progressive quadriparesis. Investigations revealed severe basilar invagination. There was assimilation of atlas and C2-3 fusion. The vertebral artery was "high-riding" into the pedicle-facet of C2 vertebra on both sides. Vertebral artery loop was exposed and mobilized inferiorly on both sides after careful drilling of pedicular bone on the posterior aspect of the dome of the artery. C2 facetal bone on the anterior face of the vertebral artery dome was now available for screw insertion. The C1-2 facets and the articulation were directly in line, making transarticular screw fixation relatively straightforward. The wide bone space available permitted insertion of 2 screws in a transarticular fashion on both sides. The patient had satisfactory clinical improvement. Imaging after 22 mo showed bone fusion across the facets.
Mobilization of the high-riding vertebral artery loop can help salvage the surgical procedure of lateral mass stabilization.
本文确定了在椎动脉处于“高位走行”位置时，在游离椎动脉后进行经关节螺钉固定的可行性。
一名42岁男性患者有4年进行性四肢瘫痪病史。检查发现严重颅底凹陷。存在寰椎融合及C2 - 3融合。双侧椎动脉“高位走行”至C2椎弓根小关节处。在动脉穹窿后部仔细钻开椎弓根骨后，双侧暴露并向下游离椎动脉袢。此时椎动脉穹窿前面的C2小关节骨可用于螺钉置入。C1 - 2小关节及关节直接对齐，使得经关节螺钉固定相对简单。宽阔的骨间隙允许双侧以经关节方式置入2枚螺钉。患者临床症状改善满意。22个月后的影像学检查显示小关节间骨融合。
游离高位走行的椎动脉袢有助于挽救侧块稳定手术。
