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Dynamic compression in vertebral artery dissection in children: apropos of a new protocol
Bruno P Braga1,2, Rafael Sillero3,4, Rosalina M Pereira5
1Department of Neurological Surgery, UT Southwestern Medical Center, Dallas, TX, USA. bruno.braga@utsouthwestern.edu.
Insights
Posterior C1C2 fusion effectively treats vertebral artery dissection in children. A strict protocol for V3 segment dissections helps prevent recurrent strokes.
Area of Science:
- Pediatric Neurology
- Vascular Surgery
- Neuroradiology
Background:
- Vertebral artery dissection (VAD) in children can lead to posterior circulation stroke.
- The V3 segment of the vertebral artery is susceptible to rotational compression.
- Identifying predisposing anatomical configurations is crucial for effective management.
Purpose of the Study:
- To report on a series of pediatric posterior circulation strokes caused by V3 segment vertebral artery dissection.
- To describe anatomical factors predisposing to rotational compression in V3 VAD.
- To recommend a new protocol for the evaluation and treatment of pediatric V3 VAD.
Main Methods:
- Prospective study of children diagnosed with V3 VAD between September 2014 and July 2020.
- Collection of demographic, clinical, surgical, and radiological data.
- Provocative angiography to assess rotational compression during diagnosis.
Main Results:
- Sixteen children (14 male, mean age 6.44 years) with V3 VAD were identified.
- Eleven children with dynamic compression underwent C1C2 posterior fusion.
- Mean follow-up of 33.3 months showed no recurrent ischemic events or major complications.
Conclusions:
- Posterior C1C2 fusion is a safe and effective treatment for dynamic compression in pediatric V3 VAD.
- Implementing a strict diagnostic and treatment protocol for V3 dissections can prevent recurrent strokes.
Purpose:
Our goals are (1) to report a consecutive prospective series of children who had posterior circulation stroke caused by vertebral artery dissection at the V3 segment; (2) to describe a configuration of the vertebral artery that may predispose to rotational compression; and (3) to recommend a new protocol for evaluation and treatment of vertebral artery dissection at V3.
Methods:
All children diagnosed with vertebral artery dissection at the V3 segment from September 2014 to July 2020 at our institution were included in the study. Demographic, clinical, surgical, and radiological data were collected.
Results:
Sixteen children were found to have dissection at a specific segment of the vertebral artery. Fourteen patients were male. Eleven were found to have compression on rotation during a provocative angiogram. All eleven underwent C1C2 posterior fusion as part of their treatment. Their mean age was 6.44 years (range 18 months-15 years). Mean blood loss was 57.7 mL. One minor complication occurred: a superficial wound infection treated with oral antibiotics only. There were no vascular or neurologic injuries. There have been no recurrent ischemic events after diagnosis and/or treatment. Mean follow-up was 33.3 months (range 2-59 months). We designed a new protocol to manage V3 dissections in children.
Conclusion:
Posterior C1C2 fusion is a safe and effective option for treatment of dynamic compression in vertebral artery dissection in children. Institution of and compliance with a strict diagnostic and treatment protocol for V3 segment dissections seem to prevent recurrent stroke.
