Tailored vertebral artery mobilisation in complex craniovertebral junction surgery

Area of Science:

• Neurosurgery
• Orthopedic Surgery
• Vascular Surgery

Background:

• Complex craniovertebral junction (CVJ) anomalies present diverse challenges, including atlantoaxial dislocation and aberrant vertebral artery (VA) courses.
• Accessing the C1-C2 joint for surgical management is often complicated by the anomalous anatomy of the VA, posing risks to neurovascular structures.

Purpose of the Study:

• To describe surgical nuances and share experience with tailored vertebral artery mobilization (VAM) for managing complex CVJ anomalies.
• To evaluate the efficacy and safety of VAM in providing a surgical corridor for C1-C2 joint access without increasing neurovascular injury risk.

Main Methods:

• Retrospective observational study of 32 patients with CVJ anomalies operated between January 2018 and December 2024.
• Collected clinical, radiological, and operative data; compared outcomes of patients with anomalous VA course (study group) versus normal VA course (control group).
• Assessed clinicoradiological improvement at three-month follow-up using Nurick's grading scale.

Main Results:

• A total of 32 patients were analyzed, with a median pre-operative Nurick's grade of 4.
• Eighteen patients underwent unilateral VAM, and fourteen underwent bilateral VAM.
• Statistically significant improvement in median post-operative Nurick's grade to 3 (P=0.002) at three months, with a mean follow-up of 28.5 months and no procedure-related mortality.

Conclusions:

• Tailored VAM is an effective surgical strategy for complex CVJ pathologies with anomalous VA.
• This technique establishes a safe surgical corridor for C1-C2 joint access, minimizing risks to neurovascular structures.
• VAM contributes to improved stability and patient recovery in CVJ anomaly management.