C3 segmental vertebral artery diagnosed by computed tomography angiography

Area of Science:

• Neurosurgery
• Vascular Anatomy
• Radiology

Background:

• The vertebral artery (VA) typically enters the skull base through the C1-2 vertebral foramen.
• Anomalous dural penetration by the VA is a rare anatomical variation.
• Previous literature documented limited cases of VA entering the subarachnoid space via the C2-3 intervertebral space.

Observation:

• A case of aberrant dural penetration of the left vertebral artery (VA) at the C2-3 vertebral level was diagnosed using computed tomography (CT) angiography.
• The patient, a 71-year-old woman with memory disturbance, also presented with aberrant right VA penetration at the C1-2 level.
• This represents a unique instance of a C3 segmental VA variation.

Findings:

• Computed tomography (CT) angiography confirmed the anomalous course of the vertebral artery (VA) penetrating the dura at the C2-3 level.
• This finding is exceptionally rare, with only a few similar cases previously reported in the literature.
• The study highlights the first diagnosed case of a C3 segmental VA using CT angiography.

Implications:

• Accurate pre-operative identification of this vertebral artery (VA) variation is essential.
• Awareness of this anomaly can help prevent inadvertent VA injury during cervical spine surgery, particularly posterior fusion procedures.
• This case underscores the importance of advanced imaging techniques like CT angiography in neurovascular anatomy assessment.