Craniovertebral junction anomaly with kissing carotids

Area of Science:

• Neurosurgery
• Vascular Anatomy
• Radiology

Background:

• The term "kissing carotids" typically describes a rare vascular anatomical variation where the internal carotid arteries approach each other in the retropharyngeal space, usually at the C4-C6 vertebral levels.
• Basilar invagination (BI) is a congenital or acquired condition where the upper cervical spine protrudes into the base of the skull.

Observation:

• A 34-year-old male presented with congenital atlantoaxial dislocation and basilar invagination.
• The planned transoral decompression (TOD) surgical approach was reconsidered.
• Preoperative computed tomography angiography (CTA) revealed an unusual anterior positioning of "kissing carotids" at the C1-C2 vertebral level.

Findings:

• The presence of "kissing carotids" at the C1-C2 level is a rare anatomical variant.
• This finding posed a significant risk during the planned transoral decompression for basilar invagination.

Implications:

• Preoperative computed tomography angiography (CTA) is essential for patients undergoing surgery for basilar invagination (BI).
• Identifying "kissing carotids" at the C1-C2 level is critical to prevent potentially catastrophic intraoperative hemorrhage.
• This case underscores the importance of detailed vascular imaging in complex craniovertebral junction pathologies.