High Cervical Spinal Cord Compression Associated with Anomaly of Bilateral Vertebral Arteries.
High Cervical Spinal Cord Compression Associated with Anomaly of Bilateral Vertebral Arteries.
复制标题
颈椎高位压迫与双侧椎动脉异常相关。
DOI：
10.1016/j.wneu.2017.10.143
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发表时间：
2018
影响因子：
2
通讯作者：
J. Shinoda
中科院分区：
文献类型：
--
作者：
Saeko Hayashi;Ryuichi Kanai;J. Shinoda
椎动脉畸形是一种罕见的疾病，通常是偶然发现的。然而，极少数情况下，它们可以表现为临床症状。我们描述了这样一例伴有持续性C2节段动脉的高位颈脊髓受压的症状。病例描述：一位67岁的男性，有5年来左侧无力和步态障碍加重的病史。磁共振成像、三维计算机断层扫描和数字减影血管成像显示椎动脉走行异常，从两侧压迫颈脊髓。有趣的是，左侧椎动脉有开窗，这可能反映了硬膜内旁正中纵轴一直发育到左侧更远的位置。采用微血管减压术移位病变椎动脉。用聚乙醇酸片和筋膜制成的血管带将压迫颈椎的椎动脉锚定在椎弓部的硬脑膜上。这种手法有效地缓解了双侧椎动脉异常所造成的神经血管冲突，患者的脊髓病变在手术后有所改善。据我们所知，这是第一次清楚地展示了这种引起临床症状的椎动脉畸形组合及其微血管减压术的成功治疗。结论锚定于椎弓根硬脑膜的椎动脉移位术是治疗这些疾病的一种有效而安全的选择。
BackgroundAnomalies of the vertebral arteries are rare and usually detected incidentally. However, very rarely, they can manifest with clinical symptoms. We describe such a symptomatic case of high cervical spinal cord compression associated with persistent C2 segmental arteries.Case DescriptionA 67-year-old man presented with a 5-year history of worsening left-sided weakness and gait disturbance. Magnetic resonance imaging, 3-dimensional computed tomography, and digital subtraction angiography revealed anomalous courses of the vertebral arteries, which compressed the cervical spinal cord at the C1 level from both sides. Interestingly, the left vertebral artery had fenestration, which supposedly reflected that the intradural paramedian longitudinal axis had developmentally persisted until more distally on the left. Microvascular decompression was performed to transpose the offending vertebral arteries. With vascular tapes made of polyglycolic acid sheets and fascia, the vertebral arteries compressing the cervical spine were anchored to the dura mater of the vertebral arch. This maneuver effectively relieved the neurovascular conflict created by the bilateral anomalous vertebral arteries, and the patient's myelopathy improved after surgery. To our knowledge, this is the first report to clearly demonstrate this combination of vertebral artery anomalies causing clinical symptoms and its successful treatment by microvascular decompression.ConclusionsTransposition of the vertebral artery by anchoring to the dura mater of the vertebral arch could be an effective and safe option for these disease conditions.