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Vertebral artery mobilization for C1-2 reduction and fixation
Michael M McDowell1, Andrew Venteicher1, Ezequiel Goldschmidt1
1Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Neurosurgical Focus: Video
|October 26, 2022
Summary
Craniocervical instability treatment involving atlantoaxial dissociation requires careful decompression and reduction. Vertebral artery mobilization during this procedure can be safely performed, preventing injury and ensuring patient stability.
Area of Science:
- Neurosurgery
- Orthopedic Surgery
- Vascular Surgery
Background:
- Craniocervical instability from chronic atlantoaxial dissociation poses surgical challenges.
- Achieving decompression, reduction, and fixation is crucial for long-term stability.
- Avoiding iatrogenic vertebral artery injury is a significant concern.
Purpose of the Study:
- To present a case of chronic atlantoaxial dissociation with basilar invagination.
- To describe the surgical technique using Goel's method with vertebral artery mobilization.
- To evaluate the safety and efficacy of this approach.
Main Methods:
- A single patient with chronic atlantoaxial dissociation and basilar invagination was treated.
- Goel's technique was employed for fixation and reduction.
- Bilateral vertebral artery mobilization was performed at the C1-2 junction.
Main Results:
- The surgery achieved substantial decompression and reduction of the craniocervical junction.
- Postoperative examination revealed a stable patient.
- No vertebral artery injury occurred during the mobilization procedure.
Conclusions:
- Vertebral artery mobilization at the C1-2 junction is a safe adjunct to craniocervical instability surgery.
- This technique can be performed via a standard suboccipital incision without complications.
- The described approach promotes stability while mitigating risks of vascular injury.
