Surgicoanatomical aspect in vascular variations of the V3 segment of vertebral artery as a risk factor for C1 instrumentation
Surgicoanatomical aspect in vascular variations of the V3 segment of vertebral artery as a risk factor for C1 instrumentation
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DOI：
10.1016/j.jocn.2019.07.032
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发表时间：
2019-10-01
影响因子：
2
通讯作者：
Kitis, Omer
中科院分区：
文献类型：
--
作者：
Arslan, Dilek;Ozer, Mehmet Asim;Kitis, Omer
目的：了解椎动脉V3段血管异常是避免医源性损伤的关键。本研究旨在分析V3节段血管变异的发生率，并证明决定C1螺钉放置手术策略的重要性。方法：研究了200例基于三维计算机断层血管造影（3D-CTA）扫描的颅颈交界区血管变异的发生率和VA的形态测量。结果：VA在通过C1后弓上的沟上方之前，通过C2的路线可变。V3节段的血管变异持续存在，包括第一节段间动脉（FIA）、椎动脉开窗（FEN）、高位（HRVA）和起源于椎动脉C1/2部分的小脑后下动脉（PICA）分支。10.1%的患者观察到HRVA，1.8%的患者观察到FIA，1.3%的患者观察到FEN，1.3%的患者观察到PICA。123例（24.1%）患者被确定为HRVA，6%存在于both sides.Conclusion：VA与FIA和FEN是罕见的，在这项研究中多达10%的VA存在于C1外侧螺钉的起始点。考虑到V3的血管解剖结构和更常见的左侧VA优势，标准螺钉插入应从右侧开始。当计划C1-C2内固定时，必须进行常规术前3D-CTA评价，以防止VA损伤。(C)2019爱思唯尔有限公司版权所有。
Object: Awareness of vascular anomalies in V3 segment of vertebral artery (VA) is crucial to avoid iatrogenic injuries during surgical procedure. This study aimed to analyze the incidence of V3 segment vascular variations and demonstrate the importance of deciding the surgical strategy for C1 screw placement.Methods: Prevalence of vascular variations and morphometric measurements of the VA in the region of the craniocervical junction in 200 cases based on three-dimensional computed tomographic angiography (3D-CTA) scans were studied.Results: The VA has a variable course through C2 before it passes above its groove on the posterior arch of C1. Following the vascular variations of V3 segments of VA were persistent including first intersegmental artery (FIA), fenestration (FEN) of the VA, high-riding (HRVA and the posterior inferior cerebellar artery (PICA) branch originating from the C1/2 part of VA. HRVA was observed in 10.1% of patients, FIA in 1.8%, FEN in 1.3%, and PICA in 1.3%. One hundred and twenty-three (24.1%) patients were identified to have HRVA, 6% present on both sides.Conclusion: The VA with FIA and FEN were rare in this study as many as a 10% the VA present over the starting point for C1 lateral screw. With respect to the vascular anatomy of V3 and more frequent left-sided VA dominancy, standard screw insertion should be started from the right side. Routine preoperative 3D-CTA evaluation is mandatory to prevent the VA injury when C1-C2 instrumentation is planned. (C) 2019 Elsevier Ltd. All rights reserved.