Risks for Vascular Injury During Anterior Cervical Spine Surgery: Prevalence of a Medial Loop of Vertebral Artery and Internal Carotid Artery
Risks for Vascular Injury During Anterior Cervical Spine Surgery: Prevalence of a Medial Loop of Vertebral Artery and Internal Carotid Artery
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颈椎前路手术期间血管损伤的风险：椎动脉内侧环和颈内动脉的患病率
DOI：
10.1097/brs.0000000000001241
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发表时间：
2016
期刊：
影响因子：
3
通讯作者：
M. Takayasu
中科院分区：
文献类型：
--
作者：
Norimitsu Wakao;Mikinobu Takeuchi;Manabu Nishimura;K. Riew;M. Kamiya;A. Hirasawa;S. Imagama;Katsuhisa Kawanami;K. Murotani;M. Takayasu
研究设计.使用回顾性单研究所数据库的观察性研究。Objective.研究椎动脉（VA）和颈内动脉（ICA）内侧袢（ML）的患病率，这可能是颈椎前路手术中动脉损伤的解剖学风险因素。背景数据总结。颈椎前路手术通常被认为是安全有效的。VA损伤是前路手术中最严重的并发症之一。有几篇文章报道了这种并发症，这可能是由于V2段VA的异常过程。然而，这些高风险病例的患病率和解剖学特征没有进行调查。方法.对2011年11月至2012年10月期间在我们机构接受对比增强计算机断层扫描（CT）或计算机断层血管造影（CTA）的连续日本受试者进行了审查，这些受试者的原因不是评估颈动脉疾病。排除标准包括图像不佳、既往手术和颈椎及其血管的血管内介入。ML的定义为VA和伊卡向钩椎关节内侧延伸。我们还调查了这些异常课程是否可通过普通CT检测。结果共调查了1251名受试者，年龄范围为14至93岁，平均年龄为56.1岁。其中，1054例受试者符合资格，其余受试者被排除。共421例受试者为男性，633例为女性。10例（1%）为VA ML，2例（0.2%）为颈内动脉内侧袢。10例椎动脉内侧袢中5例CT平扫可发现椎动脉内侧袢误入椎体。重要的是，其他5例病例在CT上无法看到。结论所有受试者中有1%在前路手术期间显示VA和伊卡损伤的解剖风险较高，其中一半无法通过平扫CT检测到。术前评估血管解剖结构可能是必要的，以确保更安全的手术治疗。证据等级：4
Study Design. Observational study using a retrospective single-institute database. Objective. To investigate the prevalence of a medial loop (ML) of the vertebral artery (VA) and internal carotid artery (ICA), which might be an anatomical risk factor for arterial injury in anterior cervical surgeries. Summary of Background Data. Anterior cervical spine surgeries are generally considered to be safe and effective. VA injury is one of the most serious complications during anterior procedures. Several articles have reported this complication, which might be because of the anomalous course of VA at V2 segment. The prevalence and anatomical features of those high-risk cases were, however, not investigated. Methods. Consecutive Japanese subjects, who underwent contrast-enhanced computed tomography (CT) or computed tomographic angiography (CTA) for reasons other than evaluation of cervical artery disease from November 2011 to October 2012 in our institution, were reviewed. Exclusion criteria included poor images, past surgery, and endovascular intervention of cervical spine and its vessels. The definition of ML was set as the course of VA and ICA extended medially inside the uncovertebral joint. We also investigated whether those anomalous courses were detectable by plain CT. Results. A total of 1251 subjects with age ranging from 14 to 93 years with a mean of 56.1 years were surveyed. Among them, 1054 subjects were eligible and the others were excluded. A total of 421 subjects were male, and 633 were female. There were 10 cases (1%) with an ML of the VA, and 2 (0.2%) cases with a medial loop of internal carotid artery. Five of the 10 cases with a medial loop of vertebral artery were aberrant into the vertebral body, which were detectable by plain CT. Importantly, the other five cases could not be seen on the CT. Conclusion. One percent of all subjects showed higher anatomical risk for VA and ICA injury during anterior surgery, half of which were undetectable by plain CT. Preoperative evaluation for vascular anatomy may be necessary for safer surgical treatment. Level of Evidence: 4