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Arterial Fencing: A Challenge During Complex Craniovertebral Junction Surgery
Kuntal Kanti Das1, Sanjeev Pattankar1, Arun Kumar Srivastava1
1Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
World Neurosurgery
|March 6, 2022
Summary
This study reports a rare case of complex craniovertebral junction anomaly in a patient with spastic quadriparesis. A novel surgical approach successfully treated the condition, involving irreducible atlantoaxial dislocation and basilar invagination with unusual vascular anomalies.
Area of Science:
- Neurosurgery
- Vascular Neurology
- Orthopedic Surgery
Background:
- Atlantoaxial dislocation and basilar invagination are complex craniovertebral junction abnormalities.
- Vascular anomalies, such as "kissing" carotids and aberrant vertebral arteries, can complicate surgical management.
- Spastic quadriparesis can be a presenting symptom of severe craniovertebral junction instability.
Observation:
- A 32-year-old woman presented with progressive spastic quadriparesis.
- Radiological evaluation revealed irreducible atlantoaxial dislocation and basilar invagination.
- Associated findings included "kissing" carotids and an anomalous right vertebral artery (VA) with intradural C3 segmental origin.
Findings:
- A complex craniovertebral junction anomaly was diagnosed, characterized by severe instability and significant vascular anomalies.
- The patient underwent a tailored posterior-only surgical approach to address the dislocation and avoid vascular injury.
- Surgical procedures included bilateral C1-C2 joint opening, C1-C2 spacer placement, and occipito-C3-C4 fixation.
Implications:
- This case highlights the importance of detailed pre-operative imaging for complex craniovertebral junction anomalies.
- A customized surgical strategy may be necessary to safely manage cases with concurrent arterial anomalies.
- This represents a potentially unique presentation of craniovertebral junction anomaly with combined carotid and vertebral artery variations.
