Variations in Entrance of Vertebral Artery in Korean Cervical Spine: MDCT-based Analysis

신혜영,박지강,박선경,정규서,최연석 대한통증학회 2014 The Korean Journal of Pain Vol.27 No.3

Background: Knowledge of the anatomical variation of the vertebral artery has clinical importance not only for the performance of interventional or surgical procedures itself but also to ensure their safety. We conducted a study of the anatomical variation by reviewing multi-detector computed tomography (MDCT) images of the cervical spine from 460 Korean patients. Methods: 16-row MDCT data from 460 patients were used in this study. We observed 920 vertebral arteries. Examination points included level of entrance of the artery into the transverse foramen of the cervical vertebra, origin site of the vertebral artery, course of a vertebral artery with aberrant entrance. Result: The vertebral artery in 2 (0.2%) cases in this study entered into the transverse foramen of the 7th cervical vertebra from the left. In 45 (4.9%) cases, the vertebral artery entered into the transverse foramen of the 5th cervical vertebra. Of these, the entrance was on the right in 15 (1.6%) and on the left in 30 (3.3%). We found 17 (1.8%) cases in which the artery entered into the transverse foramen of the 4th cervical vertebra, 10 (1.1%) on the right and 7 (0.7%) on the left side. As is commonly acknowledged, the 6th cervical vertebra was the most common site of entry; the vertebral artery entered the transverse foramen of the 6th cervical vertebra in the remaining 855 (93.0%) cases, on the right in 434 (47.2%) and on the left in 421 (45.8%). Conclusions: In conclusion, the possibility of an atypical course of the vertebral artery in segments V1 and V2 should be evaluated with magnetic resonance imaging (MRI) or CT images before carrying out procedures involving the anterior cervical vertebrae.

Variations in Entrance of Vertebral Artery in Korean Cervical Spine: MDCT-based Analysis

Shin, Hye Young,Park, Ji Kang,Park, Sun Kyung,Jung, Gyu Seo,Choi, Yun Suk The Korean Pain Society 2014 The Korean Journal of Pain Vol.27 No.3

Background: Knowledge of the anatomical variation of the vertebral artery has clinical importance not only for the performance of interventional or surgical procedures itself but also to ensure their safety. We conducted a study of the anatomical variation by reviewing multi-detector computed tomography (MDCT) images of the cervical spine from 460 Korean patients. Methods: 16-row MDCT data from 460 patients were used in this study. We observed 920 vertebral arteries. Examination points included level of entrance of the artery into the transverse foramen of the cervical vertebra, origin site of the vertebral artery, course of a vertebral artery with aberrant entrance. Result: The vertebral artery in 2 (0.2%) cases in this study entered into the transverse foramen of the 7th cervical vertebra from the left. In 45 (4.9%) cases, the vertebral artery entered into the transverse foramen of the 5th cervical vertebra. Of these, the entrance was on the right in 15 (1.6%) and on the left in 30 (3.3%). We found 17 (1.8%) cases in which the artery entered into the transverse foramen of the 4th cervical vertebra, 10 (1.1%) on the right and 7 (0.7%) on the left side. As is commonly acknowledged, the 6th cervical vertebra was the most common site of entry; the vertebral artery entered the transverse foramen of the 6th cervical vertebra in the remaining 855 (93.0%) cases, on the right in 434 (47.2%) and on the left in 421 (45.8%). Conclusions: In conclusion, the possibility of an atypical course of the vertebral artery in segments V1 and V2 should be evaluated with magnetic resonance imaging (MRI) or CT images before carrying out procedures involving the anterior cervical vertebrae.

Review Article : Variations in Entrance of Vertebral Artery in Korean Cervical Spine: MDCT-based Analysis

( Hye Young Shin ),( Ji Kang Park ),( Sun Kyung Park ),( Gyu Seo Jung ),( Yun Suk Choi ) 대한통증학회 2014 The Korean Journal of Pain Vol.27 No.3

Background: Knowledge of the anatomical variation of the vertebral artery has clinical importance not only for the performance of interventional or surgical procedures itself but also to ensure their safety. We conducted a study of the anatomical variation by reviewing multi-detector computed tomography (MDCT) images of the cervical spine from 460 Korean patients. Methods: 16-row MDCT data from 460 patients were used in this study. We observed 920 vertebral arteries. Examination points included level of entrance of the artery into the transverse foramen of the cervical vertebra, origin site of the vertebral artery, course of a vertebral artery with aberrant entrance. Result: The vertebral artery in 2 (0.2%) cases in this study entered into the transverse foramen of the 7th cervical vertebra from the left. In 45 (4.9%) cases, the vertebral artery entered into the transverse foramen of the 5th cervical vertebra. Of these, the entrance was on the right in 15 (1.6%) and on the left in 30 (3.3%). We found 17 (1.8%) cases in which the artery entered into the transverse foramen of the 4th cervical vertebra, 10 (1.1%) on the right and 7 (0.7%) on the left side. As is commonly acknowledged, the 6th cervical vertebra was the most common site of entry; the vertebral artery entered the transverse foramen of the 6th cervical vertebra in the remaining 855 (93.0%) cases, on the right in 434 (47.2%) and on the left in 421 (45.8%). Conclusions: In conclusion, the possibility of an atypical course of the vertebral artery in segments V1 and V2 should be evaluated with magnetic resonance imaging (MRI) or CT images before carrying out procedures involving the anterior cervical vertebrae.

척추동맥 손상의 위험성

김성완(Seong Wan Kim),염진섭(Jin S. Yeom),권윤주(Yoon Ju Kwon),유승민(Seung Min You),안영희(Young Hee An),박건우(Kun-Woo Park),장봉순(Bong-Soon Chang),이춘기(Choon-Ki Lee) 대한정형외과학회 2008 대한정형외과학회지 Vol.43 No.5

목적: 제 1-2 경추간 경관절 나사와 제 2 경추 관절하 분절 나사 삽입 시 척추동맥 손상의 위험성을 CT를 이용한 나사 삽입 시뮬레이션으로 비교하고자 하였다. 대상 및 방법: 총 166명의 환자의 1 ㎜ 간격 CT 영상과 나사 삽입 시뮬레이션 소프트웨어를 이용하여 상기 두 나사의 삽입을 컴퓨터 시뮬레이션 하여, 나사에 의한 제 2 경추 척추동맥구 침범의 발생율을 비교하였다. 이 중 상위 척추동맥에서의 척추동맥구 침범의 발생률을 다시 비교하였다. 결과: 전체 166명에 두 가지 나사를 각각 삽입한 결과, 제 1-2 경추간 경관절 나사는 9.9% (33/332), 제 2 경추 관절하 분절 나사는 5.7% (19/332)의 척추동맥구 침범을 일으켜, 통계적으로 유의한 차이를 보였다(p=0.001, McNemar test). 상위 척추동맥 48개만을 분리하여 분석해 본 결과, 제 1-2 경추간 경관절 나사는 62.5% (30/48), 제 2 경추 관절하 분절 나사는 37.5% (18/48)의 척추동맥구 침범을 일으켜, 통계적으로 유의한 차이를 보였다(p=0.002, McNemar test). 결론: 제 2 경추 관절하 분절 나사는 제 1-2 경추간 경관절 나사보다 척추동맥 손상의 위험성이 낮았으며, 상위 척추동맥의 경우에도 척추동맥 손상의 위험성이 낮았다. Purpose: We compared the risk of vertebral artery injury associated with the insertion of C1-2 transarticular screws and C2 subarticular segmental screws using a computer simulation of computed tomography (CT) scans. Materials and Methods: We simulated the placement of C1-2 transarticular screws and C2 subarticular segmental screws using 1-mm interval CT scan images in 166 patients, along with simulation software. We then determined the incidence of violation of the C2 vertebral artery groove. The same determination was performed for high-riding vertebral arteries found among those patients. Results: Among the 332 C2 vertebral artery grooves (166 patients), C1-2 transarticular screws violated the groove in 33 (9.9%) instances, while C2 subarticular segmental screws violated the groove in 19 (5.7%) instances. The difference in incidence between the two screw types was statistically significant (p=0.001, McNemar test). In the 48 high-riding vertebral arteries, C1-2 transarticular screws led to violation of the C2 vertebral artery groove in 30 (62.5%) instances, while C2 subarticular segmental screws led to violation of the groove in 18 (37.5%) instances. The difference in incidence between the two screw types was statistically significant (p=0.002, McNemar test). Conclusion: Use of C2 subarticular segmental screws is associated with a lower risk of vertebral artery injury than is the use of C1-2 transarticular screws, even for high-riding vertebral arteries.

Rotational Vertebral Artery Syndrome (Bow Hunter’s Syndrome): A Rare Differential Diagnosis in Patients With Syncope

In-Seo Hong,Eun-Ho Jung,Kyung Hwan Kim,Hyon-Jo Kwon,Seung Won Choi,Seon-Hwan Kim,Hyeon-Song Koh,Jin-Young Youm,이한주 대한신경손상학회 2022 Korean Journal of Neurotrauma Vol.18 No.2

Syncope is a common symptom in clinical practice. Rotational vertebral artery occlusion syndrome, also referred to as Bow Hunter’s syndrome (BHS), is a rare condition associated with syncope and is caused by mechanical occlusion or stenosis secondary to mechanical compression of the vertebral artery during head rotation. BHS is associated with a multifactorial etiology; however, in most cases, this condition is attributed to degenerative changes. A 53-year-old man visited our hospital for the evaluation of fainting and dizziness episodes that occurred when he turned his head. Evaluation as an outpatient in the Department of Neurology showed a positive result on the Frenzel goggle test. Transfemoral cerebral angiography performed at the Department of Neurosurgery revealed stenosis of the proximal right vertebral artery. Complete occlusion of the vertebral artery was observed, and the head was turned to the right. Decompression and fusion were performed, and the contributory lesion was completely removed. Postoperative imaging confirmed complete removal of the spur and sufficient vertebral artery decompression; the patient’s symptoms resolved postoperatively.

자발성 두개강내 추골동맥 박리의 진단 및 치료

안경순,김성민,김용한,심영보,송준호,오세문,최선길 대한신경외과학회 1996 Journal of Korean neurosurgical society Vol.25 No.6

The authors have dealt with six cases of spontaneous intracranial vertebral artery dissection during the past 3 years. Most of the patients were in their fourth or fifth decade of life, and men predominated. All except one patient had severe antecedent headache and half of the 6 cases were hypertensive. The presenting clinical features were subarachnoid hemorrhage. Wallenberg's syndrome, brain stem RIND (reversible ischemic neurologic deficit) and cerebellar infarct. The locations of the dissection were right vertebral artery in four patients, right vertebral and basilar artery in one and left vertebral artery in another one. Most of the patients showed typical intramural hematoma or double lumen on the MRI. On the MR angiography, irregular segmental narrowing of vertebral artery or invisible pathologic vertebral artery were demonstrated. The angiographic findings included alternating irregular stenotic and dilated segment(pearl and string sign), aneurysmal dilatation occulusion etc. Four patients were treated medically while the other two were treated surgically by proximal vertebral artery clipping of the affected artery. Upon follow-up, the outcome were excellent in two good in two and fair in two.

Occlusion of Both Vertebral Arteries With Development of Collateral Circulation From the Deep Cervical Artery After Cervical Spine Trauma

Junik Son,Tae Yong An,Myeong Jin Ko,Seung Won Park,Young-Seok Lee 대한신경손상학회 2022 Korean Journal of Neurotrauma Vol.18 No.2

Careful evaluation of vertebral artery injuries is important after cervical translation injuries or transverse foramen fractures. Treatment of trauma can be complicated in cases of concomitant vertebral artery injuries. A 76-year-old woman was admitted to our hospital with left hemiparesis (Motor grade 3) after a motorcycle accident. Cervical spine magnetic resonance imaging (MRI) and computed tomography (CT) revealed a C3 burst fracture and a left C3 lateral mass and lamina fracture. CT angiography revealed fracture fragments that predisposed the vertebral artery to injury throughout its course in the area. CT angiography confirmed that both vertebral arteries were occluded at the C3 fracture site. Subsequent brain MRI revealed acute infarction in the right occipital area. Although both vertebral arteries were occluded, the infarction site did not correspond to the territory supplied by these vessels; therefore, we performed transfemoral cerebral angiography, which revealed collateralization of the bilateral vertebral arteries by the deep cervical artery.. The deep cervical arteries are located between the posterior muscles; therefore, a fixation operation performed using the posterior approach may have affected the collateral circulation and led to exacerbation of the infarction site. Therefore, surgery was performed using an anterior approach and it was possible to minimize the risk of cerebral infarction through preservation of collateral circulation.

Downbeat Nystagmus Associated With Brainstem Compression by Vertebral Artery

Moon, Ki-Hyoung,Lee, Sang-Ahm,Ahn, Jae-Sung,Kwun, Byung-Duk The Korean Neurosurgical Society 2007 Journal of Korean neurosurgical society Vol.41 No.3

Rarely, downbeat nystagmus can occur due to compression of the lower brainstem by the ectatic vertebral artery and be resolved by microvascular decompression. We present a case of a 67-year-old man with downbeat nystagmus associated with brainstem compression by ectatic vertebral artery. He presented with oscillopsia and vertigo. When he turned his head upward, his symptoms were aggravated and a gait disturbance occurred. Magnetic resonance imaging and computed tomographic angiography demonstrated compression of the medulla oblongata by the left ectatic vertebral artery and other medical causes of downbeat nystagmus were ruled out. Retromastoid craniotomy was performed and after lifting the vertebral artery off the medulla, a trough-shaped indentation in the lower brainstem was identified. The ectatic vertebral artery was repositioned and a Teflon was inserted between the brainstem and the ectatic vertebral artery. Postoperatively, downbeat nystagmus had disappeared.

Inconspicuous longitudinal tears of the intracranial vertebral artery in traumatic basal subarachnoid hemorrhage

김성호 대한병리학회 2020 Journal of Pathology and Translational Medicine Vol.54 No.2

Blunt force trauma to the head or neck region can cause traumatic basal subarachnoid hemorrhage (TBSAH), which can result in rapid loss of consciousness and death; however, detecting such a vascular injury is difficult. Posterior neck dissection was performed to investigate the bleeding focus in TBSAH cases 2018 and 2019. In all four cases, autopsies revealed a longitudinal tear in the midsection of the vertebral artery’s intracranial portion. The midportion of the intracranial vertebral artery appears to be most vulnerable to TBSAH. Interestingly, three of the cases showed only a vaguely visible longitudinal fissure in the artery without a grossly apparent tear; rupture was confirmed by microscopic examination. Longitudinal fissures of the intracranial vertebral artery, which are difficult to identify without detailed examination, may be overlooked in some cases of TBSAH. Thus, careful gross and microscopic examination of the vertebral artery is recommended in cases of TBSAH.

Acute Unilateral C5 Nerve Root Palsy Caused by Venous Engorgement Associated with the Tortuous Vertebral Artery: A Case Report

이승환,이인식 대한근전도전기진단의학회 2019 대한근전도 전기진단의학회지 Vol.21 No.2

The existence of tortuous vertebral artery as a result of developmental anomaly is very rare condition. Previously, there were case reports that tortuous vertebral artery was associated with headache or cervical pain, however there was no report that was related to motor weakness by cervical root compression caused by venous engorgement associated with tortuous vertebral artery. This case study demonstrates a case of a patient with proximal muscle weakness in the left upper extremity due to venous engorgement associated with tortuous vertebral artery, and C5 nerve root palsy caused by it. We will discuss the cause of the disease and suggest effective treatment for it.