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Bilateral persistent 'second' intersegmental vertebral arteries: illustrated with a case.
Madhivanan Karthigeyan1, Pravin Salunke2, Mandeep Singh Kataria2
1Department of Neurosurgery, Postgraduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh, 160012, India. karthigeyanm82@gmail.com.
Acta Neurochirurgica
|June 24, 2018
Summary
This study identifies a rare anatomical variation of the vertebral artery (VA) in patients with craniovertebral junction deformities. Recognizing this unusual VA course is crucial for preventing surgical injury during C2 screw placement.
Area of Science:
- Anatomy
- Neurosurgery
- Vascular Surgery
Background:
- Congenital craniovertebral junction deformities can present with anomalous vertebral artery (VA) anatomy.
- Posterior crossing of the VA (persistent first intersegmental artery) poses a risk during posterior surgical approaches.
Observation:
- A novel variant of bilateral VA course is described.
- The VA exited C3 transverse foramina, coursed medially beneath the C2 pars interarticularis, and entered the foramen magnum.
Findings:
- This anomalous VA pathway did not involve the C2 transverse foramen.
- The variant is potentially linked to bilateral persistent second intersegmental arteries.
Implications:
- Recognition of this unusual VA variant is critical for neurosurgeons.
- Avoiding VA injury during C2 pars or transarticular screw insertion is paramount.