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Year : 2021  |  Volume : 69  |  Issue : 2  |  Page : 241--242

Vertebral Artery Course Variations and Implications in Craniovertebral Junction Surgeries

Sandeep Kandregula, Bharat Guthikonda 
 Department of Neurosurgery, LSU Health Sciences, Shreveport, USA

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How to cite this article:
Kandregula S, Guthikonda B. Vertebral Artery Course Variations and Implications in Craniovertebral Junction Surgeries.Neurol India 2021;69:241-242

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Kandregula S, Guthikonda B. Vertebral Artery Course Variations and Implications in Craniovertebral Junction Surgeries. Neurol India [serial online] 2021 [cited 2021 Jun 18 ];69:241-242
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Course of the vertebral artery varies slightly with an incidence of 2-3% in normal population. These variations are more commonly seen in craniovertebral junction anomalies with an incidence reaching nearly 20%. Iatrogenic VA injuries can cause extensive intra-operative bleeding and sometimes permanent neurological deficits. Identifying the course of VA is of paramount importance in preventing the injury. VA injury can occur either during dissection or at screw placement. C1 screw insertion is associated with VA injury than C2 screw placement.[1] The best strategy for dealing with VA injury is prevention. Pre-operative assessment of VA course through 3D CT angiography or MR angiography helps identifying abnormal course if present. Although pre-operative assessment identifies the course, tracing the VA course intra-operatively might be difficult sometimes due to the destruction of anatomical landmarks in surgeries especially decompression and screw placement. In these situations, surgeons might consider intra-operative 3D CT or ICG and doppler sonography to identify in real time.[2] Nevertheless, these utilities have some critical limitations like difficulty to visualize in deeper planes and monitoring only the patency but not the quality of blood flow. The combination of various modalities along with careful microscopic dissection and anatomical knowledge helps to minimize the VA injuries in CVJ surgeries. In this illustration we show normal variation along with abnormal course of the vertebral artery. Although the course of VA can vary highly with numerous variations which cannot be demonstrated in one illustration, we intend to show the importance of pre-operative assessment of VA course.

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1Yi H, Hong J, Lee J. Analysis of risk factors for posterior C1 screw-related complication: a retrospective study of 358 posterior C1 screws. Oper Neurosurg (Hagerstown) 2019;17:509-17.
2Lee DH, Park JH, Lee JJ, et al. Intraoperative surveillance of the vertebral artery using indocyanine green angiography and Doppler sonography in craniovertebral junction surgeries. Neurosurgical Focus 2021;50:E5.