Vertebral artery injury during cervical discectomy and fusion in a patient with bilateral anomalous arteries in the disc space: case report

Neurosurgery
Brian R GantwerkerWilliam L White

Abstract

Our goal was to increase the safety of anterior cervical discectomy, a routine surgery performed by neurosurgeons worldwide, in the face of vertebral artery (VA) anomalies. A 59-year-old woman had an intraoperative injury of the left VA during elective anterior cervical discectomy and fusion from C3 to 7. Retrospective analysis of her magnetic resonance images showed bilateral anomalous VAs. Intervention postoperatively, a pseudoaneurysm developed that was subsequently coiled. The patient underwent embolization of the pseudoaneurysm and sacrifice of the parent vessel by endovascular neurosurgical techniques. She had no neurological sequelae but did have some difficulty swallowing. Radiologists, neuroradiologists, and surgeons should note the location and course of the VA in their routine evaluation of cervical magnetic resonance images. Neuroradiologists should alert surgeons to the possibility of anomalous VAs that are at risk of injury during surgery. Ultimately, it remains the responsibility of the surgeon to carefully review the images, assess for vascular anomalies, and plan the surgery accordingly.

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Citations

Jul 14, 2012·European Spine Journal : Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society·Hyung-Ki Park, Hae-Dong Jho
Jul 20, 2012·European Spine Journal : Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society·Ronald H M A Bartels
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Oct 9, 2015·Anatomy Research International·Santosh Kaur SangariEstomih Phillip Mtui
Feb 11, 2012·Journal of Korean Neurosurgical Society·Hyeun Jin JungSung Myung Lee
Jun 7, 2017·World Neurosurgery·Evgenii BelykhPeter Nakaji
May 27, 2017·Clinical Anatomy : Official Journal of the American Association of Clinical Anatomists & the British Association of Clinical Anatomists·Gabrielle G TardieuR Shane Tubbs
Oct 6, 2019·Operative Neurosurgery·Fabian WinterAlexander P Hughes
Jul 11, 2020·Case Reports in Neurology·Sarkis Morales VidalAri Gordin

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