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Bilateral arcuate foramen decompression for posterior circulation stroke in a child-case report and literature review
Florence R A Hogg1, Luke Smith2, Felice D'Arco3
1Department of Neurosurgery, Great Ormond Street Hospital for Children, London, UK. florencehogg@me.com.
Insights
Vertebral artery (VA) dissection in children can cause posterior circulation stroke due to arcuate foramen (AF) compression. Surgical decompression is a viable treatment option for this rare condition, as demonstrated in a recent pediatric case.
Area of Science:
- Neurology
- Pediatric Neurosurgery
- Vascular Surgery
Background:
- Posterior circulation stroke in children is rare.
- Vertebral artery (VA) dissection can be caused by compression within the arcuate foramen (AF), a congenital anomaly of the C1 vertebra.
- Surgical techniques for VA decompression in pediatric cases are not well-documented.
Purpose of the Study:
- To review existing literature on surgical management of symptomatic AF.
- To describe a pediatric case of posterior circulation infarction secondary to VA dissection associated with bilateral AF.
- To highlight the utility of 3D-printed guides in surgical planning and execution.
Main Methods:
- Literature review conducted using PubMed and Google Scholar.
- Case report of a 15-year-old boy with bilateral AF presenting with posterior circulation infarction.
- Bilateral surgical VA decompression utilizing 3D-printed intraoperative guides.
Main Results:
- Ten papers identified, covering 106 patients surgically treated for AF-related VA compression, mostly via a posterior midline approach.
- Successful surgical decompression in the reported pediatric case with stable neurophysiological monitoring and no complications.
- Uneventful postoperative recovery, with the patient remaining stroke-free at 7-month follow-up, experiencing resolution of headaches and hypertension.
Conclusions:
- Arcuate foramen (AF)-related vertebral artery (VA) compression is a rare but treatable cause of pediatric posterior circulation stroke.
- Thorough assessment of cervical spine anatomy is crucial in pediatric posterior circulation stroke cases.
- Surgical decompression is a potential therapeutic option when AF is identified as the cause.
Introduction:
Posterior circulation stroke resulting from vertebral artery (VA) dissection in children is rare but may occur secondary to compression of the VA within the arcuate foramen (AF), a well-described congenital anomaly of the C1 vertebra. There is limited documentation of the surgical technique for VA decompression in such cases.
Objectives:
To review the literature on the surgical management of symptomatic AF and to describe a paediatric case of posterior circulation infarction secondary to VA dissection associated with bilateral AF.
Methods:
A literature review was performed using PubMed and Google Scholar. Additionally, we report the case of a 15-year-old boy with bilateral AF who presented with posterior circulation infarction from VA dissection and underwent bilateral surgical VA decompression utilising 3D-printed intraoperative guides for operative planning and execution.
Results:
Ten papers were identified comprising 106 patients who underwent surgical decompression for AF-related VA compression, predominantly managed via a posterior midline approach. In our case, surgical decompression was successfully achieved with stable intraoperative neurophysiological monitoring and no complications. Postoperative recovery was uneventful, and the patient remained stroke-free at 7-month follow-up with complete resolution of headaches and hypertension.
Conclusions:
AF-related VA compression represents a rare but potentially treatable cause of paediatric posterior circulation stroke. Careful assessment of cervical spine anatomy should be performed in cases of paediatric posterior circulation stroke, and surgical decompression may be considered when AF is identified.
