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Updated: Jul 8, 2026
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Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Vertebral artery anomaly with entry at C4--avoiding a surgical pitfall: a case report
Matthias Müller1, Joachim Bleeck, Michael Ruf
1Department of Trauma, Hand and Reconstructive Surgery, University Hospital Jena, Erlanger Allee 101, 07747, Jena, Germany. MatthiasMueller@traumascores.com
Summary
A rare vertebral artery (VA) entrance at C4 was found in a patient with severe spinal trauma. Early diagnosis of this unusual VA anatomy is crucial to prevent potentially fatal surgical complications.
Area of Science:
- Neurosurgery
- Anatomy
- Radiology
Background:
- Vertebral artery (VA) anomalies are uncommon but can pose significant risks during cervical spine surgery.
- Preoperative identification of aberrant VA anatomy is critical for surgical planning and patient safety.
Observation:
- A case report details a patient with traumatic C3-C4 fracture-dislocation and quadriplegia.
- Preoperative magnetic resonance imaging (MRI) revealed an unusual unilateral intra-foraminal entrance of the VA at the C4 level.
- This represents a rare anatomical variant, with no prior clinical case reports of VA entrance at C4 in recent literature.
Findings:
- The patient underwent successful surgical decompression and stabilization via an anterior-posterior approach without intraoperative complications.
- The unusual VA anatomy was identified preoperatively, allowing for tailored surgical management.
Implications:
- This case highlights the importance of recognizing rare vertebral artery anomalies, such as high or intra-foraminal entrance.
- Preoperative diagnosis of such anatomical variations is essential to avoid catastrophic intraoperative hemorrhage and neurological injury.
- Enhanced awareness and diagnostic vigilance for VA anomalies can improve surgical outcomes in complex cervical spine trauma.
