Auswahl der wissenschaftlichen Literatur zum Thema „Vertebral Artery, injuries“

Abstract Introduction: The second part of the vertebral artery along with vertebral venous plexus and sympathetic plexus traverses through vicinity of foramen transversarium of atlas. Derangement of these structures in their course may be seen due to deformities, narrowing and presence of osteophytes in foramen transversarium. Methods: Two hundred foramen transversarium of 100 atlas vertebrae were grossly studied for their variations. Results: Out of hundred atlas vertebrae examined, we found that all the vertebrae had foramina transversaria. Absence of costal element was noticed in five atlas vertebrae. 2 of the vertebrae showed incomplete unilateral foramen transversarium, 3 vertebrae showed bilateral incomplete foramen, In 1 vertebra along with normal foramen transversarium, complete retroarticular foramen was observed on the left side and incomplete retroarticular foramen observed on the right side of the posterior arch.4 vertebrae showed incomplete retroarticular foramen. Conclusion: The increasing incidence of neck injuries and related syndromes necessitates the study of bony variations of the atlas vertebra and its transverse foramina. Due to the incomplete formation of the foramen transversarium the second part of vertebral artery is prone to be damaged easily during posterior cervical injuries and Surgeries. The bony bridges embracing the vertebral artery may be responsible for vertigo and cerebrovascular accidents hence the knowledge of such variations is important for Physicians, Otirhinolaryngologists, neurologists ,Orthopaedicians and Radiologists.

Abstract BACKGROUND: Iatrogenic vertebral artery injury is a rare neurosurgical complication, but it is potentially fatal. The majority of vertebral artery injuries are encountered during cervical spine instrumentation, and craniotomy-related injuries have been encountered during the far-lateral approach. OBJECTIVE: To present the first reported case of iatrogenic vertebral artery injury occurring during retrosigmoid craniotomy, in the setting of an anomalous vertebral artery course within the suboccipital musculature. METHODS: A 70-year-old man underwent elective retrosigmoid craniotomy for meningioma resection. During exposure, iatrogenic injury to the third segment of the vertebral artery occurred above the craniocervical junction. His vertebral arteries were codominant. The artery was primarily repaired and the operation was aborted. He was treated with aspirin, remained neurologically intact, and was discharged the next day. RESULTS: Immediate and 5-week vascular imaging studies demonstrated vessel patency. After 5 weeks, the patient returned for elective tumor resection, which was uncomplicated, and he remained neurologically intact at 10-week follow-up. CONCLUSION: The rarity of vertebral artery injuries and lack of previous such complications involving retrosigmoid craniotomy highlight the need for vigilance during any suboccipital exposure. Complication avoidance is possible by using several preoperative and intraoperative checks. When an injury has occurred, rapid assessment and management of the event is necessary, while primary repair may be more difficult following electrocautery-mediated laceration. Successful treatment of iatrogenic vertebral arterial injuries has been described, but the most frequently reported management has been endovascular sacrifice of the injured vessel, which carries inherent risks of vertebrobasilar insufficiency in a dominant vertebral artery.

The aim of the study was to analyze the results of spinal artery damage treatment of the injured. Materials and methods. An 2-year analysis of treating 7 patients with vertebral artery injuries admitted to the City Hospital (GB) No. 26 of St. Petersburg was carried out. The problems of diagnosing and treating these injuries have been identified. The solutions to these problems have been suggested. Two clinical cases of successful treatment of injured patients with spinal artery damage have been presented. Results. Theres a possibility of damaging vertebral arteries in neck injuries thus defining the need for introducing high-informative methods of inspection (a spiral computer tomography contrast angiography, a Magnetic Resonance Imaging) and low-invasive (X-ray endovascular) interventions in urgent surgery. The implementation of complex instrumental examinations, their nature, the number of them and urgency should be determined by a surgeon individually considering the recommendations of related specialists. Conclusions. Regardless of the wound size and the patients condition, examination and treatment of patients with neck injuries should be carried out in large hospitals with angiosurgeon and other narrow specialists in the panel of doctors with the 24-hour surveillance, as well as access to full examination and high-tech urgent operational interventions.

Spinal column injuries are very commonly diagnosed in the multitrauma population, and extensive distraction injuries are often fatal due to cerebrovascular injuries or spinal cord injuries. We present a 62-year-old female who presented after an MVC with a 2-cm vertical distraction injury of C5-6 with a right vertebral artery transection and left vertebral artery dissection. She received multidisciplinary treatment which resulted in her survival, albeit with severe neurologic deficits. We challenge the current literature that suggests a blunt vertebral artery transection is 100% fatal.

Aim: It is not uncommon for vertebral artery injury to occur when there are fractures through the transverse foraminae of the first to the sixth vertebral bodies. Other important risk factors for vertebral artery injury include facet joint dislocations and fractures of the first to the third cervical vertebral bodies. The aim of this study was to determine the pattern and prevalence of vertebral artery injury on CT angiography (CTA) in patients with cervical spine fractures.Method: A retrospective review of patients who had undergone CTA of the vertebral arteries was undertaken. Reports were reviewed to determine which patients met the inclusion criteria of having had both cervical spine fractures and CTA of the vertebral arteries. Images of patients who met the inclusion criteria were analysed by a radiologist.Results: The prevalence of vertebral artery injury was 33%. Four out of the 11 patients who had vertebral artery injury, had post-traumatic spasm of the artery, with associated thrombosis or occlusion of the vessel. In terms of blunt carotid vertebral injury (BCVI) grading, most of the patients sustained grade IV injuries. Four patients who had vertebral artery injury had fractures of the upper cervical vertebrae, i.e. C1 to C3. Fifteen transverse process fractures were associated with vertebral artery injury. No vertebral artery injury was detected in patients who had facet joint subluxations.Conclusion: Patients with transverse process fractures of the cervical spine and upper cervical vertebral body fractures should undergo CTA to exclude vertebral artery injury.

Vertebral artery injuries as a result of blunt trauma can result in vertebrobasilar strokes. Typical treatment of such an injury includes early anticoagulation to prevent cerebral ischemic events due to vessel occlusion or embolism. We present a case of cervical fracture-dislocation injury and compression/occlusion of the right vertebral artery, which spontaneously resolved following surgical reduction and fusion. Postoperative cerebral angiography showed no evidence of vertebral artery stenosis, and systemic anticoagulation was discontinued. This case shows that vertebral artery occlusion can resolve spontaneously after fracture reduction, and cerebral angiography should play a role in assessing these complicated traumatic injuries.

Introdução: As lesões contusas de artérias carótidas e vertebrais (LCCV) não são muito frequentes, porém podem apresentar repercussões graves. A incidência desse tipo de lesão é difícil de ser avaliada porque os doentes podem estar neurologicamente assintomáticos quando atendidos no pronto socorro ou podem apresentar sintomas que são atribuídos ao trauma de crânio ou a outras lesões associadas. Estatísticas recentes apontam uma incidência de 0,24% a 0,33% em doentes traumatizados portadores de algum sintoma neurológico. No Brasil não existem trabalhos de nosso conhecimento que tenham estudado a incidência das LCCV. Por outro lado, a real morbidade e mortalidade das LCCV não estão claramente determinadas, nem mesmo na literatura internacional. Os objetivos deste estudo foram: a) avaliar a incidência de LCCV em 100 doentes vítimas de trauma contuso submetidos à angiotomografia cervical, utilizando parâmetros obtidos da avaliação clínica inicial e das tomografias de crânio e da região cervical e b) verificar quais os critérios de indicação da angiotomografia cervical que mais se correlacionam com a presença de LCCV no serviço de trauma de hospital quaternário brasileiro. Material e Método: Durante o período de trinta meses a partir de julho de 2006, todos os doentes admitidos no Pronto-Socorro do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, com trauma cervical fechado, com potencial risco de lesão dos vasos cervicais apresentando défice neurológico não justificado pela tomografia computadorizada de crânio, infarto cerebral, hematoma cervical estável, epistaxe volumosa, anisocoria/sinal de Horner, escore na escala de coma de Glasgow abaixo de 8 sem achados justificativos pela tomografia, fratura de coluna cervical, fratura de base de crânio, fratura de face (Le Forte II ou III), sinal do cinto de segurança acima da clavícula, frêmito ou sopro cervical, foram incluídos no estudo. Os doentes foram encaminhados para a angiotomografia cervical para diagnóstico das LCCV. Foram analisados também mecanismo de trauma, sexo, idade, gravidade do trauma, gravidade das LCCV, tipo de tratamento e evolução. Os doentes foram divididos em dois grupos: sem LCCV (Grupo I) e com LCCV (Grupo II). Os dados analisados são apresentados como média e desvio padrão da média e as análises estatísticas foram realizadas com os testes de Qui-Quadrado e Exato de Fisher, e o teste de Mann-Whitney. Foi usado um nível de significância de 5% (p-valor <=0,05). Resultado: Foram atendidos 2.467 doentes vítimas de trauma contuso. Em 100 doentes que apresentaram critérios para inclusão, no estudo a angiotomografia identificou 23 com LCCV, 17 do sexo masculino e 6 do sexo feminino. A idade média foi de 34,81±14,84 anos. Colisão de auto (49%) e atropelamento (24%) foram os mecanismos de trauma mais frequentes seguidos de queda de grande altura (18%), e outros mecanismos (9%). Dez doentes tiveram lesão de carótida interna, 2 doentes com lesão de carótida comum, onze doentes com lesão de vertebral. Sete doentes apresentaram lesão arterial grau I, 10 grau II, 4 grau IV e I grau V e uma fístula de carótida. Sete (30,4%) dos 23 doentes com LCCV apresentavam fratura de vértebras cervicais e 11 (47,8%) apresentavam fratura de face (LeFort II e III). Dezessete doentes foram tratados clinicamente e seis doentes foram submetidos a tratamento endovascular (um stent e cinco embolizações). Conclusão: Os critérios utilizados neste estudo permitiram o diagnóstico de LCCV em 0,93% dos casos, sendo que tais lesões ocorreram nos traumatizados mais graves, e não influenciaram a morte na população estudada
Background: Blunt trauma of the carotid and vertebral arteries (LCCV) are infrequent, but may have serious repercussions. The incidence of this type of injury is difficult to evaluate as many patients are neurologically asymptomatic when assisted in emergency rooms, or with symptoms attributed to cranium trauma or to other associated injuries. Recent statistical data show an incidence of 0.24% to 0.33% traumatized patients that carry some neurological symptom, we are not aware of any papers in Brazil that have studied the occurrence of LCCV. On the other hand, the real morbidity and mortality are not clearly determined, not even in the international literature. The objectives of the current study were: a) to evaluate the incidence of carotid and vertebral artery injuries in 100 patients with blunt trauma subjected to cervical angiography, using parameters obtained from the initial clinical evaluation and tomography of the patients and b) to verify which criteria for recommending cervical angiography are most related to the presence of LCCV in the trauma services section in a Brazilian quaternary care hospital. Method: During thirty months, starting in July 2006, all patients admitted in the emergency room of Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, with blunt cervical trauma, with potential risk of injuries to cervical vessels that presented neurological deficit unexplained after cranial CT scan, cerebral infarction, stable cervical haematomas, severe epistaxis, anisocoria/sign of Horner`s syndrome, Glasgow coma scores bellow 8 that are not explained by CT scan, cervical spine fracture, basilar skull fracture, facial fracture (Le Forte II or III), seatbelt signals above the clavicle, cervical hum or bruit were included in the study. The patients were subjected to cervical angiography in order to diagnose LCCV. There were analyzed the mechanisms of injuries, gender, age, severity of LCCV, type of treatment and outcome. The patients were divided into two groups: without LCCV (Group I) and with LCCV (Group II). The data analyzed are presented as mean minus standard deviation and the statistical analyzes were done using Chi-square and Fisher`s exact tests, and the Mann-Whitney test. For date comparison, a p-value <=0,05 was considered significant. Results: 2.467 patients, victims of blunt trauma, were included in the study. In 100 patients that presented the criteria for the inclusion in the study, the angiography identified 23 with LCCV, 17 male and 6 female. The mean age was 34,81±14,84 years. Car crash (49%) and car-pedestrian accidents (24%) were the most frequent mechanisms of injury, followed by falling from altitude (18%), and other mechanisms (9%). Ten patients suffered internal carotid artery injury, 2 patients with common carotid artery injury, and eleven patients with vertebral artery injury. Seven patients presented arterial injury level I, 10 level II, 4 level IV and 1 level V and one carotid fistula. Seven (30,4%) out of the 23 patients with LCCV presented cervical vertebrae fractures and 11 (47,8%) presented facial fracture (LeFort II e III). Seventeen patients were treated clinically and six underwent endovascular treatment (one stent and five embolizations). Conclusion: The criteria used in this study have allowed the diagnosis of LCCV in 0,93% of the cases, those being such injuries that occurred in the most seriously traumatized patients, and did not lead to death in the studied population.

Chapter 48 discusses the differential diagnosis of the most common athletic head injuries, including cerebral concussion, intracranial hemorrhage, second impact syndrome or malignant brain oedema syndrome, post-concussion syndrome, , along with management guidelines for athletic head injuries, including immediate treatment, definitive treatment, what tests to order, when to refer, when to operate, and when to return to competition. Management and return to play guidelines are presented for athletic spine and spinal cord injuries, including spine fractures and spinal cord concussion/contusion and hemorrhage. Also covered are the diagnosis and management of stingers which may involve injury to the brachial plexus or cervical nerve root, vascular injuries of the neck involving either the carotid or vertebral artery, and special concerns regarding the Down’s Syndrome patient and atlantoaxial (C1–2) subluxation.

This chapter in the Oxford Handbook of Emergency Medicine investigates major trauma in the emergency department (ED). It reviews general treatment principles, resuscitation, and investigations, and explores airway obstruction, tension pneumothorax, rib fractures, sternal fracture, flail segment, ruptured diaphragm, oesophageal rupture, traumatic pneumothorax, haemothorax, chest drain insertion, pulmonary contusions and aspiration, penetrating chest injury, open chest injury, traumatic cardiac arrest, thoracotomy for cardiac arrest, aortic injury, focused assessment with sonography for trauma (FAST) scan, blunt abdominal trauma, penetrating abdominal trauma, renal trauma, bladder injury, urethral trauma, scrotal and testicular trauma, minor and serious head injury, post-concussion symptoms, carotid/vertebral artery dissection, maxillofacial injuries, mandibular injuries, temporomandibular joint dislocation, penetrating neck trauma, silver trauma, spine and spinal cord injury, dermatomes, gunshot injuries, blast injuries, burns, inhalation injury, and crush syndrome.