Prevalence of Vertebral artery anomaly in upper cervical and its surgical implications: a systematic review
Prevalence of Vertebral artery anomaly in upper cervical and its surgical implications: a systematic review
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上颈椎椎动脉异常的患病率及其手术意义：系统评价
DOI：
10.1007/s00586-021-07015-8
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发表时间：
2021
影响因子：
2.8
通讯作者：
Xiaofeng Yin
中科院分区：
文献类型：
--
作者：
Xi Lin;H. Zhu;Yang Xu;Ting Zheng;Fei;Xiaofeng Yin
背景上颈椎椎动脉（VA）异常的存在可能是上颈椎后路手术中灾难性并发症的潜在原因。本研究的目的是证明真实的发生率的V3段异常的患者需要进行上颈椎手术，并试图找出V3段异常的危险因素，以评估是否有必要进行计算机断层血管造影（CTA）的上颈椎手术。纳入了涉及具有上颈椎椎动脉异常数据的人类受试者的回顾性研究和病例系列报告。数据的患病率持续第一intersegmentated动脉（PIA），开窗的VA（FA），小脑后下动脉（PICA）被extracted.ResultsA共16篇文章，涉及5927例符合纳入标准。骨性异常患者中V3异常的总发生率为25.9%（74/286），其中PIA为17.5%，FA为6.6%，PICA为1.8%。在无骨性异常的患者中，V3段异常的总发生率为2.7%（152/5671），其中PIA为1.76%，FA为0.4%，PICA为0.5%。无骨性异常的亚洲人群V3段异常的总发生率为5.8%，而欧洲和美国人群分别为0.8%和0.6%.ConclusionPatients with bone abnormalities are high-risk factor for VA abnormalities，CTA是评价VA解剖变异的重要手段。然而，考虑到正常人群V3变异的发生率较低，我们不建议将术前CT血管造影作为术前的强制性部分。
BackgroundThe presence vertebral artery (VA) abnormalities in the upper cervical may be a potential cause of catastrophic complication in the posterior approach of the upper cervical spine surgery. The aim of this study was to demonstrate the real incidence of the V3 segment anomaly in patients who need upper cervical surgery, and tried to find out the risk factors of V3 segment anomaly to evaluate the necessary of computed tomographic angiography (CTA) for upper cervical surgery.MethodThis systematic review was conducted following the preferred reporting items for systematic reviews and meta-Analyses (PRISMA). Retrospective studies and reports of case series involving human subjects with data on anomalies of vertebral artery in upper cervical spine were included. Data on the prevalence of persistent first intersegmental artery (PIA), fenestration of the VA (FA), posterior inferior cerebellar artery (PICA) were extracted.ResultsA total of 16 articles involving 5927 subjects met the inclusion criteria. The total incidence of V3 segment anomaly in the patients with bony abnormalities was 25.9% (74/286): PIA was 17.5%, FA was 6.6% and PICA was 1.8%. The total incidence of V3 segment anomaly in the patients without bony abnormalities was 2.7% (152/5671): PIA was 1.76%, FA was 0.4% and PICA was 0.5%. The total incidence of V3 segment anomaly in Asian population without bony abnormalities was 5.8%, while in European and American population was 0.8 and 0.6%, respectively.ConclusionPatients with bone abnormalities are high risk factor for VA abnormalities, CTA is of paramount importance to evaluate the variant VA anatomy. However, regarding to the low incidence of V3 variation in normal population, we do not recommend preoperative CT angiography as mandatory part of preoperative.