Moskopp Mats L, Sannwald Lennart W, Burbelko Michael, Moskopp Dag
1Department of Neurosurgery, Vivantes Friedrichshain Hospital, Charité Academic Teaching Hospital, Berlin, Germany.
2Institute of Physiology, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; and.
J Neurosurg Case Lessons. 2023 Apr 24;5(17). doi: 10.3171/CASE2358.
Blunt vertebral artery injuries after cervical trauma due to the close anatomical relationship of the vertebral artery to the cervical spine may have fatal consequences because of posterior circulation ischemia and vertebrobasilar insufficiency. While the standard of care remains medical treatment by anticoagulation or antiplatelet therapy, surgical decompression of the vertebral artery is rarely indicated.
The authors present a case of selective decompression of a traumatically constricted vertebral artery within the transverse foramen of C2 presenting with vertebrobasilar insufficiency due to bilateral aplasia of the posterior communicating arteries and contralateral hypoplasia of the vertebral artery.
Because of their close relationship to the cervical spine, the vertebral arteries are at risk for blunt injury, which may present asymptomatically or with symptoms of posterior circulation ischemia or vertebrobasilar insufficiency either immediately or after a latency phase. The anatomical variability of (1) the vertebral arteries, (2) collateral brainstem perfusion, and (3) the individual injury pattern demands individualized treatment strategies. If endovascular treatment of hemodynamically relevant stenosis of the V2 segment of the vertebral artery poses too high a risk for vessel injury, decompression of the transverse foramen can be performed safely and without risk to the biomechanical stability of the cervical spine.
由于椎动脉与颈椎的解剖关系密切，颈椎创伤后钝性椎动脉损伤可能因后循环缺血和椎基底动脉供血不足而产生致命后果。虽然治疗标准仍是抗凝或抗血小板治疗，但很少需要对椎动脉进行手术减压。
作者报告了一例对C2横突孔内受创伤性狭窄的椎动脉进行选择性减压的病例，该患者因双侧后交通动脉发育不全和对侧椎动脉发育不良而出现椎基底动脉供血不足。
由于椎动脉与颈椎关系密切，有钝性损伤风险，可能无症状，或立即出现后循环缺血或椎基底动脉供血不足症状，也可能在潜伏期后出现。（1）椎动脉、（2）脑干侧支灌注以及（3）个体损伤模式的解剖变异需要个体化的治疗策略。如果对椎动脉V2段血流动力学相关狭窄进行血管内治疗对血管损伤风险过高，则可安全地进行横突孔减压，且不会对颈椎的生物力学稳定性造成风险。
