Nishiura T, Fujiwara K, Handa A, Gotoh M, Tsuno K, Ishimitsu H
Department of Neurosurgery, Iwakuni National Hospital, Japan.
No Shinkei Geka. 1998 Jan;26(1):45-50.
We report a rare case of myelopathy caused by compression of the upper cervical cord by the bilateral anomalous vertebral arteries. A 49-year-old man had dragged his right foot for 4 years. He also complained of a tingling sensation in his right arm and occipitalgia. Neurological examination disclosed right hemiparesis, hypalgesia in the right half of the body and hypertonicity of the lower extremities. MRIs showed a flow void area which compressed and distorted the spinal cord bilaterally at the level of the atlas. A vertebral angiogram showed that the bilateral vertebral arteries had pierced the dura matter under the posterior arch of the atlas, turned upward and laterally in the vertebral canal, making vascular loops at the level of the atlas. 3D CT angiography showed the loops convex medially in the anterior part of the vertebral canal. With these findings, we diagnosed the patient as suffering compression of the cervical cord by the bilateral anomalous vertebral arteries. Suboccipital craniectomy and C1 laminectomy were performed. When the dura mater was opened, the dorsolateral aspect of the spinal cord was found to be compressed and indented markedly by the vertebral arteries. To decompress the spinal cord, the vertebral arteries were retracted dorsolaterally by means of Gore-tex tape and anchored to the spinous process of the axis. Postoperatively, his neurological symptoms improved. Postoperative MRIs showed that the spinal cord was decompressed and had recovered its contour. A review of the literature revealed that only 3 such cases as this one have been reported. The clinical features of these rare cases are nonspecific myelopathy and concomitant occipitalgia or neck pain. The main cause of this rare entity seemed to be the compression of the vertebral artery through its course when it enters the vertebral canal between the atlas and the axis.
我们报告一例罕见的因双侧椎动脉异常压迫颈上段脊髓导致的脊髓病。一名49岁男性右脚拖地4年。他还主诉右臂有刺痛感和枕部疼痛。神经系统检查发现右侧偏瘫、身体右半侧感觉减退以及下肢肌张力增高。磁共振成像（MRI）显示在寰椎水平有一个血流空洞区域，双侧压迫并扭曲脊髓。椎动脉血管造影显示双侧椎动脉穿破寰椎后弓下方的硬脑膜，在椎管内向上并向外侧走行，在寰椎水平形成血管袢。三维CT血管造影显示这些血管袢在椎管前部向内侧凸出。根据这些发现，我们诊断该患者为双侧椎动脉异常压迫颈髓。行枕下颅骨切除术和C1椎板切除术。打开硬脑膜时，发现脊髓背外侧明显被椎动脉压迫并出现压痕。为了减压脊髓，通过戈尔泰克斯（Gore-tex）带将椎动脉向背外侧牵开并固定在枢椎棘突上。术后，他的神经症状有所改善。术后MRI显示脊髓得到减压且恢复了外形。文献回顾显示，仅报道过3例类似本病例的情况。这些罕见病例的临床特征为非特异性脊髓病并伴有枕部疼痛或颈部疼痛。这种罕见病症的主要原因似乎是椎动脉在进入寰椎和枢椎之间的椎管时其走行过程中受到压迫。
