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Journal articles on the topic 'Vertebral Artery, injuries'

Author: Grafiati

Published: 4 June 2021

Last updated: 1 February 2022

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1

Roberts, Lawrence H., and Demetrios Demetriades. "Vertebral artery injuries." Surgical Clinics of North America 81, no. 6 (December 2001): 1345—IN2. http://dx.doi.org/10.1016/s0039-6109(01)80011-6.

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2

Sultana, Qudusia, Ramakrishna Avadhani, Varalakshmi KL, and Shariff MH. "VARIATIONS OF FORAMEN TRANSVERSARIUM IN ATLAS VERTEBRAE : A MORPHOLOGICAL STUDY WITH ITS CLINICAL SIGNIFICANCE." Journal of Health and Allied Sciences NU 05, no. 02 (June 2015): 080–83. http://dx.doi.org/10.1055/s-0040-1709822.

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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.

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3

Osorio, Joseph A., Arnau Benet, Christopher P. Hess, Michael W. McDermott, and Adib A. Abla. "Primary Vertebral Artery Reanastomosis During Retrosigmoid Skull Base Approach Following Iatrogenic Near-Transection With Monopolar Electrocautery." Operative Neurosurgery 10, no. 4 (August 29, 2014): 631–39. http://dx.doi.org/10.1227/neu.0000000000000526.

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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.

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Glushkov, Nikolay I., Vladimir F. Rylkov, Konstantin V. Sementsov, Anatoliy V. Skorodumov, Alexey A. Moiseev, Valentin V. Alekseev, Taras E. Koshelev, and Anastasia O. Votinova. "Experience of surgical treatment of vertebral artery injuries." HERALD of North-Western State Medical University named after I.I. Mechnikov 12, no. 2 (August 21, 2020): 45–50. http://dx.doi.org/10.17816/mechnikov202012245-50.

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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.

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5

Hatzitheofilou, C., D. Demetriades, J. Melissas, M. Stewart, and J. Franklin. "Surgical approaches to vertebral artery injuries." British Journal of Surgery 75, no. 3 (March 1988): 234–37. http://dx.doi.org/10.1002/bjs.1800750315.

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6

Demetriades, D., D. Theodorou, J. Asensio, S. Golshani, H. Belzberg, A. Yellin, F. Weaver, and T. V. Berne. "Management options in vertebral artery injuries." British Journal of Surgery 83, no. 1 (January 1996): 83–86. http://dx.doi.org/10.1002/bjs.1800830126.

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7

Arthurs, Zachary M., and Benjamin W. Starnes. "Blunt carotid and vertebral artery injuries." Injury 39, no. 11 (November 2008): 1232–41. http://dx.doi.org/10.1016/j.injury.2008.02.042.

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8

Griffard, Jared, and Reagan Bollig. "Right Vertebral Artery Transection With a Vertical Distraction of C5-6: Case Report of a Patient Survival." American Surgeon 86, no. 5 (May 2020): 531–33. http://dx.doi.org/10.1177/0003134820919725.

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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.

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9

Ismail, Farzanah, Silas Motsitsi, Nausheen Khan, and Inger Fabris-Rotelli. "The pattern and prevalence of vertebral artery injury in patients with cervical spine fractures." South African Journal of Radiology 17, no. 2 (June 11, 2013): 52–55. http://dx.doi.org/10.4102/sajr.v17i2.243.

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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.

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10

Yaeger, Kurt, Justin Mascitelli, Christopher Kellner, Zachary Hickman, J. Mocco, and Konstantinos Margetis. "Temporary vertebral artery occlusion after C3 fracture dislocation injury and spontaneous resolution following reduction and instrumented fusion: case report and literature review." Journal of NeuroInterventional Surgery 9, no. 10 (October 18, 2016): 1027–30. http://dx.doi.org/10.1136/neurintsurg-2016-012671.

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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.

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11

Schroeder, GregoryD, and WellingtonK Hsu. "Vertebral artery injuries in cervical spine surgery." Surgical Neurology International 4, no. 6 (2013): 362. http://dx.doi.org/10.4103/2152-7806.120777.

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12

Sticco, Andrew, Sagar Ghandi, Bryan Knoedler, Geoff Marston, Alex Ewing, Gene Langan, and Christopher Carsten. "Current Outcomes of Blunt Vertebral Artery Injuries." Journal of Vascular Surgery 71, no. 1 (January 2020): e16-e17. http://dx.doi.org/10.1016/j.jvs.2019.10.032.

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13

Lunardini, David J., Mark S. Eskander, Jesse L. Even, James T. Dunlap, Antonia F. Chen, Joon Y. Lee, Timothy W. Ward, James D. Kang, and William F. Donaldson. "Vertebral artery injuries in cervical spine surgery." Spine Journal 14, no. 8 (August 2014): 1520–25. http://dx.doi.org/10.1016/j.spinee.2013.09.016.

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14

Aguwa, Okezie, Ian Behr, Howard S. An, and Daniel K. Park. "Vertebral Artery Injuries and Blunt Cervical Trauma." Contemporary Spine Surgery 14, no. 5 (May 2013): 1–7. http://dx.doi.org/10.1097/01.css.0000429584.23039.bc.

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&NA;. "Vertebral Artery Injuries and Blunt Cervical Trauma." Contemporary Spine Surgery 14, no. 5 (May 2013): 8. http://dx.doi.org/10.1097/01.css.0000429585.99206.2b.

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&NA;. "Vertebral Artery Injuries and Blunt Cervical Trauma." Contemporary Spine Surgery 14, no. 7 (July 2013): 5. http://dx.doi.org/10.1097/01.css.0000431779.90134.27.

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17

Mwipatayi, B. P., P. Jeffery, S. J. Beningfield, P. Motale, J. Tunnicliffe, and P. H. Navsaria. "Management of Extra-cranial Vertebral Artery Injuries." European Journal of Vascular and Endovascular Surgery 27, no. 2 (February 2004): 157–62. http://dx.doi.org/10.1016/j.ejvs.2003.11.008.

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18

Albuquerque, Felipe C., Sam P. Javedan, and Cameron G. McDougall. "Endovascular Management of Penetrating Vertebral Artery Injuries." Journal of Trauma: Injury, Infection, and Critical Care 53, no. 3 (September 2002): 574–80. http://dx.doi.org/10.1097/00005373-200209000-00032.

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19

Sticco, Andrew, Sagar S. Gandhi, Bryan Knoedler, Geoff Marston, Alex Ewing, Eugene M. Langan, and Christopher G. Carsten. "Current Outcomes of Blunt Vertebral Artery Injuries." Annals of Vascular Surgery 70 (January 2021): 252–57. http://dx.doi.org/10.1016/j.avsg.2020.07.045.

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20

Altafulla, Juan, Emre Yilmaz, Stefan Lachkar, Joe Iwanaga, Jacob Peacock, Zachary Litvack, and R. Shane Tubbs. "Neck movement during cervical transforaminal epidural injections and the position of the vertebral artery: an anatomical study." Acta Radiologica Open 8, no. 3 (March 2019): 205846011983468. http://dx.doi.org/10.1177/2058460119834688.

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Background Cervical transforaminal epidural steroid injections (CTFESIs) are sometimes performed in patients with cervical radiculopathy secondary to nerve-root compression. Neck movements for patient positioning may include rotation, flexion, and extension. As physicians performing such procedures do not move the neck for fear of injuring the vertebral artery, we performed fluoroscopy and cadaveric dissection to analyze any movement of the vertebral artery during head movement and its relation to the foramina in the setting of CTFESI. Purpose To determine cervical rotational positioning for optimized vertebral artery location in the setting of cervical transforaminal epidural steroid injections. Material and Methods Four sides from two Caucasian whole cadavers (all fresh-frozen) were used. Using a guide wire and digital subtraction fluoroscopy, we evaluated the vertebral artery mimicking a CTFESI, then we removed the transverse processes and evaluated the vertebral artery by direct observation. Results After performing such maneuvers, no displacement of the vertebral artery was seen throughout its course from the C6 to the C2 intervertebral foramina. To our knowledge, this is the first anatomical observation of its kind that evaluates the position of the vertebral artery inside the foramina during movement of the neck. Conclusion Special caution should be given to the medial border of the intervertebral foramina when adjusting the target site and needle penetration for the injection. This is especially true for C6-C4 levels, whereas for the remaining upper vertebrae, the attention should be focused on the anterior aspect of the foramen. Since our study was centered on the vertebral artery, we do not discard the need for contrast injection and real-time digital subtraction fluoroscopy while performing the transforaminal epidural injection in order to prevent other vascular injuries.

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21

Fakoya, Adegbenro Omotuyi John, Erica Barnes, Faviola Laureano-Torres, Adrian Felciano Muniz, Emmanuel Morales Monsanto, Darimar Loubriel, Emilio Aguinaldo, Abayomi Gbolahan Afolabi, and Thomas McCracken. "Fenestrated Vertebral Artery in A Routine Cadaveric Dissection." Open Access Macedonian Journal of Medical Sciences 7, no. 13 (July 9, 2019): 2154–56. http://dx.doi.org/10.3889/oamjms.2019.563.

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BACKGROUND: Anomalies associated with the vertebral arteries are relatively rare. The vertebral arteries arise from the first part of the Subclavian artery and pass through the transverse foramina of C6 through C1. CASE PRESENTATION: However, in this article, we describe a unique variation in the anatomical orientation of the right vertebral artery during a routine cadaveric neck dissection where the right vertebral artery gives an oblique branch from the extradural segment (C2) forming a fenestrated Vertebral artery. CONCLUSION: Despite the lack of established clinical significance, multiple co-morbid vascular malformations are yet associated with the Vertebral artery fenestration with a possibility of iatrogenic injuries if not taking into cognisance.

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22

Burlew, Clay Cothren, and Walter L. Biffl. "Imaging for Blunt Carotid and Vertebral Artery Injuries." Surgical Clinics of North America 91, no. 1 (February 2011): 217–31. http://dx.doi.org/10.1016/j.suc.2010.10.004.

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23

Greer, Lauren T., Reed B. Kuehn, David L. Gillespie, Paul W. White, Randy S. Bell, Rocco A. Armonda, and Charles J. Fox. "Contemporary management of combat-related vertebral artery injuries." Journal of Trauma and Acute Care Surgery 74, no. 3 (March 2013): 818–24. http://dx.doi.org/10.1097/ta.0b013e31827a08a8.

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24

Sud, Sunjay, Moiz Ali, Kari Stammen, Elizabeth Yu, Nikhil Jain, and Safdar N. Khan. "Cervical fracture patterns associated with vertebral artery injuries." Current Orthopaedic Practice 28, no. 1 (2017): 48–51. http://dx.doi.org/10.1097/bco.0000000000000446.

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25

Lee, Young-Jun, Jung Yong Ahn, In Bo Han, Young Sun Chung, Chang Ki Hong, and Jin Yang Joo. "Therapeutic Endovascular Treatments for Traumatic Vertebral Artery Injuries." Journal of Trauma: Injury, Infection, and Critical Care 62, no. 4 (April 2007): 886–91. http://dx.doi.org/10.1097/01.ta.0000209398.07973.60.

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26

Herrera, D. A., S. A. Vargas, and A. B. Dublin. "Endovascular Treatment of Traumatic Injuries of the Vertebral Artery." American Journal of Neuroradiology 29, no. 8 (May 22, 2008): 1585–89. http://dx.doi.org/10.3174/ajnr.a1123.

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27

Asensio, Juan A., Parinaz J. Dabestani, Florian A. Wenzl, Stephanie S. Miljkovic, John J. Kessler, Carlos A. Fernandez, Tyson Becker, et al. "A systematic review of penetrating extracranial vertebral artery injuries." Journal of Vascular Surgery 71, no. 6 (June 2020): 2161–69. http://dx.doi.org/10.1016/j.jvs.2019.10.084.

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28

SCHWARZ, NIKOLAUS, WALTER BUCHINGER, TITUS GAUDERNAK, FRIEDRICH RUSSE, and WOLFGANG ZECHNER. "Injuries to the Cervical Spine Causing Vertebral Artery Trauma." Journal of Trauma: Injury, Infection, and Critical Care 31, no. 1 (January 1991): 127–33. http://dx.doi.org/10.1097/00005373-199101000-00025.

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29

Yee, Lawrence J., Eric W. Dicot, and M. Margaret Knudson. "EXTERNAL TRANSLUMINAL AND OBSERVATIONAL TREATMENT FOR VERTEBRAL ARTERY INJURIES." Journal of Trauma: Injury, Infection, and Critical Care 37, no. 1 (July 1994): 159. http://dx.doi.org/10.1097/00005373-199407000-00065.

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30

Hassanzadeh, Hamid, Philip Louie, Sreeharsha V. Nandyala, Kevin Park, and Howard S. An. "Management of Vertebral Artery Injuries During Oncologic Spine Procedures." Contemporary Spine Surgery 16, no. 2 (February 2015): 1–7. http://dx.doi.org/10.1097/01.css.0000460492.37321.d0.

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&NA;. "Management of Vertebral Artery Injuries During Oncologic Spine Procedures." Contemporary Spine Surgery 16, no. 2 (February 2015): 8. http://dx.doi.org/10.1097/01.css.0000460493.10879.b4.

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32

Blickenstaff, Kurt L., Fred A. Weaver, Albert E. Yellin, Steven C. Stain, and Ethel Finck. "Trends in the management of traumatic vertebral artery injuries." American Journal of Surgery 158, no. 2 (August 1989): 101–6. http://dx.doi.org/10.1016/0002-9610(89)90355-3.

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33

Mihindu, Esther, and James Dennis. "Changing Patterns In Vertebral Artery Injuries Diagnosis And Management." Annals of Vascular Surgery 38 (January 2017): 5. http://dx.doi.org/10.1016/j.avsg.2016.10.016.

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34

Coss, Catherine, and Jeffrey Jones. "Bilateral Carotid and Vertebral Artery Dissection from Blunt Trauma." Case Reports in Emergency Medicine 2018 (2018): 1–3. http://dx.doi.org/10.1155/2018/1919034.

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Carotid and vertebral artery injuries are rare following blunt trauma. They can, however, lead to severe consequences with a significant associated rate of stroke and intracranial hemorrhage, particularly if the diagnosis and treatment are delayed. We report a case of a 23-year-old female who presented to the Emergency Department with bilateral carotid and vertebral artery dissection following a motor vehicle collision (MVC).

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35

Van der Merwe, Braham, Christelle Ackermann, Shaun Scheepers, and Sulaiman Moosa. "Is anomalous origin of the left vertebral artery indeed a rare finding?" South African Journal of Radiology 16, no. 4 (November 28, 2012): 144–46. http://dx.doi.org/10.4102/sajr.v16i4.262.

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We present a pictorial review of anomalous origin of the left vertebral artery observed in 5 patients imaged in our after-hours trauma radiology unit within a period of 7 days. We raise the question of whether the incidence of anomalous origin of the left vertebral artery quoted in the radiology literature as 5% is really that low, and suggest that the current increased frequency of cross-sectional imaging could elevate the observed incidence of this anomaly in practice. We discuss the implications of vertebral artery anomalies in the endovascular treatment of aortic arch injuries.

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36

Ortega-Balderas, Jessica A., Miguel A. Sada-Treviño, Francisco J. Barrera-Flores, Pablo P. Zárate-Garza, Roberto A. Lugo-Guillén, Arnulfo Gómez-Sánchez, Ricardo Pinales-Razo, Guillermo Elizondo-Riojas, Santos Guzmán-López, and Rodrigo E. Elizondo-Omaña. "Avoiding iatrogenic injuries to the vertebral artery: A morphometric study of the vertebral artery-free dissection area." Clinical Neurology and Neurosurgery 196 (September 2020): 106001. http://dx.doi.org/10.1016/j.clineuro.2020.106001.

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37

Dobies-Krześniak, Barbara, and Beata Tarnacka. "Vertebral Artery Dissection Following Cervical Spine Injury as a Diagnostic Challenge. Case Study." Ortopedia Traumatologia Rehabilitacja 21, no. 5 (October 31, 2019): 369–78. http://dx.doi.org/10.5604/01.3001.0013.5788.

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Head and neck injuries are common and can be associated with cervical vessel injury. In some cases, the correct diagnosis of artery dissection can be a real challenge given the nonspecific signs. We present the case of a spinal cord-injured patient with neurological sequelae and delayed posterior circulation stroke caused by bilateral vertebral artery dissection. The signs of cerebellar and occipital lobe ischemia were masked by manifestations of spinal cord injury. The patient was unconscious and in a serious condition, but, despite no proper stroke treatment, only residual dysarthria and upper limb ataxia were seen after rehabilitation. Any clinical suspicion based on the combination of head or neck trauma with atypical or evolving neurological symptoms should be verified for the possibility of a vertebral artery dissection.

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38

Fassett, Daniel R., Andrew T. Dailey, and Alexander R. Vaccaro. "Vertebral Artery Injuries Associated With Cervical Spine Injuries: A Review of the Literature." Journal of Spinal Disorders & Techniques 21, no. 4 (June 2008): 252–58. http://dx.doi.org/10.1097/bsd.0b013e3180cab162.

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39

Tannoury, Chadi, and Anthony Degiacomo. "Fatal Vertebral Artery Injury in Penetrating Cervical Spine Trauma." Case Reports in Neurological Medicine 2015 (2015): 1–5. http://dx.doi.org/10.1155/2015/571656.

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Study Design. This case illustrates complications to a vertebral artery injury (VAI) resulting from penetrating cervical spine trauma.Objectives. To discuss the management of both VAI and cervical spine trauma after penetrating gunshot wound to the neck.Summary of Background Data.Vertebral artery injury following cervical spine trauma is infrequent, and a unilateral VAI often occurs without neurologic sequela. Nevertheless, devastating complications of stroke and death do occur.Methods. A gunshot wound to the neck resulted in a C6 vertebral body fracture and C5–C7 transverse foramina fractures. Neck CT angiogram identified a left vertebral artery occlusion. A cerebral angiography confirmed occlusion of the left extracranial vertebral artery and patency of the remaining cerebrovascular system. Following anterior cervical corpectomy and stabilization, brainstem infarction occurred and resulted in death.Results. A fatal outcome resulted from vertebral artery thrombus propagation with occlusion of the basilar artery triggering basilar ischemia and subsequent brainstem and cerebellar infarction.Conclusions. Vertebral artery injury secondary to cervical spine trauma can lead to potentially devastating neurologic sequela. Early surgical stabilization, along with anticoagulation therapy, contributes towards managing the combination of injuries. Unfortunately, despite efforts, a poor outcome is sometimes inevitable when cervical spine trauma is coupled with a VAI.

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40

Gallo, Pasquale, Amauri Dalacorte, Eduardo Raupp, Amir J. Santos, Marcos R. C. Frank, and Glauco A. Saraiva. "Giant pseudoaneurysm of the extracranial vertebral artery: case report." Arquivos de Neuro-Psiquiatria 54, no. 2 (June 1996): 297–303. http://dx.doi.org/10.1590/s0004-282x1996000200019.

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Pseudoaneurysms of the extracranial vertebral artery are extremely rare due to their deep location and the anatomical protection of this artery. They can be caused by cervical traumas (firearm injuries, sports, hyperextension of the neck and iatrogeny). The authors report the case of a patient who developed a giant pseudoaneurysm of the extracranial vertebral artery after surgery for the removal of a tumor of the cerebellopontine angle in which surgical lesion of the artery occurred. Treatment was performed by endovascular approach. Literature is reviewed and comments are made on the physiopathogeny of the lesion and the different forms of treatment.

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41

Lloyd, R. V., P. E. O'Flynn, and N. S. Jones. "Access to the traumatized vertebral artery: an unusual approach." Journal of Laryngology & Otology 113, no. 1 (January 1999): 76–78. http://dx.doi.org/10.1017/s002221510014321x.

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AbstractAlthough injuries to the vertebral arteries are relatively uncommon, there are several different methods used to gain access to these vessels, and to control any bleeding arising from them. We describe a case of torrential oropharyngeal bleeding following a stab wound to the neck in which rapid access to the vertebral artery was gained using a paramedian mandibulotomy; this approach has not previously been documented. The other approaches are discussed.

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42

Yu, Jeong Sik, Tae Sub Chung, Young Soo Kim, Yong Eun Cho, Byung Chul Kang, and Dong Ik Kim. "MR Manifestations of Vertebral Artery Injuries in Cervical Spine Trauma." Journal of the Korean Radiological Society 35, no. 5 (1996): 667. http://dx.doi.org/10.3348/jkrs.1996.35.5.667.

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43

Harrigan, Mark R., Mark N. Hadley, Sanjay S. Dhall, Beverly C. Walters, Bizhan Aarabi, Daniel E. Gelb, R. John Hurlbert, Curtis J. Rozzelle, Timothy C. Ryken, and Nicholas Theodore. "Management of Vertebral Artery Injuries Following Non-Penetrating Cervical Trauma." Neurosurgery 72, suppl_3 (March 1, 2013): 234–43. http://dx.doi.org/10.1227/neu.0b013e31827765f5.

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44

Raskind, Robert, and Charles M. North. "Vertebral Artery Injuries Following Chiropractic Cervical Spine Manipulation —Case Reports." Angiology 41, no. 6 (June 1990): 445–52. http://dx.doi.org/10.1177/000331979004100605.

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Kloen, P., J. D. Patterson, B. I. Wintman, R. M. Ozuna, and G. W. Brick. "Closed cervical spine trauma associated with bilateral vertebral artery injuries." Archives of Orthopaedic and Trauma Surgery 119, no. 7-8 (November 15, 1999): 478–81. http://dx.doi.org/10.1007/s004020050027.

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Scott, William W., Steven Sharp, Stephen A. Figueroa, Alexander L. Eastman, Charles V. Hatchette, Christopher J. Madden, and Kim L. Rickert. "Clinical and radiological outcomes following traumatic Grade 3 and 4 vertebral artery injuries: a 10-year retrospective analysis from a Level I trauma center. The Parkland Carotid and Vertebral Artery Injury Survey." Journal of Neurosurgery 122, no. 5 (May 2015): 1202–7. http://dx.doi.org/10.3171/2014.9.jns1461.

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OBJECT Grade 3 and 4 blunt vertebral artery (VA) injuries may carry a different natural course from that of lower-grade blunt VA injuries. Proper screening, management, and follow-up of these injuries remain controversial. Grade 3 and 4 blunt VA injuries were analyzed to define their natural history and establish a rational management plan based on lesion progression and cerebral infarction. METHODS A retrospective review of a prospectively maintained database of all blunt traumatic carotid and vertebral artery injuries from August 2003 to April 2013 was performed, and Grade 3 and 4 blunt VA injuries were identified. Grade 3 injuries were defined as stenosis of the vessel greater than 50% or the development of a pseudoaneurysm, and Grade 4 injuries were defined as complete vessel occlusion. Demographic information, radiographic imaging findings, number of imaging sessions performed per individual, length of radiographic follow-up, radiographic outcome at end of follow-up, treatment(s) provided, and documentation of ischemic stroke or transient ischemic attack were recorded. RESULTS A total of 79 high-grade (Grade 3 and 4) blunt VA injuries in 67 patients were identified. Fifty-nine patients with 66 high-grade blunt VA injuries were available for follow-up. There were 17 patients with 23 Grade 3 injuries and 42 patients with 43 Grade 4 injuries. The mean follow-up duration was 58 days for Grade 3 and 67 days for Grade 4 blunt VA injuries. Repeat imaging of Grade 3 blunt VA injuries showed that 39% of injuries were radiographically stable, 43% resolved, and 13% improved, while 1 injury radiographically worsened. Repeat imaging of the Grade 4 blunt VA injuries showed that 65% of injuries were radiographically stable (persistent occlusion), 30% improved (recanalization of the vessel), and in 2 cases (5%) the injury resolved. All Grade 3 injuries that were treated were managed with aspirin or clopidogrel alone, as were the majority of Grade 4 injuries. There were 3 cerebral infarctions thought to be related to Grade 4 blunt VA injuries, which were likely present on admission. All 3 of these patients died at a mean of 13.7 days after hospital admission. No cerebral infarctions directly related to Grade 3 blunt VA injuries were identified. CONCLUSIONS The majority of high-grade blunt VA injuries remain stable or are improved at final follow-up. Despite a 4% rate of radiographic worsening in the Grade 3 blunt VA injury group and a 35% recanalization rate in the Grade 4 blunt VA injury group, there were no adverse clinical outcomes associated with these radiographic changes. No cerebral infarctions were noted in the Grade 3 group. A 7% stroke rate was identified in the Grade 4 blunt VA injury group; however, this was confined to the immediate postinjury period and was associated with 100% mortality. While these data suggest that these high-grade vertebral artery injuries may require less intensive radiographic follow-up, future prospective studies are needed to make conclusive changes related to treatment and management.

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Sudhakar, K., R. Manimaran, Dhanesh Kumar Kasinathan, and Bipin Chaurasia. "Incidence of Traumatically Induced Vertebral Artery Occlusion Associated with Cervical Spine Injuries: Prospective Study Using Magnetic Resonance Angiography." International Journal of Neurology and Neurosurgery 10, no. 3 (2018): 242–51. http://dx.doi.org/10.21088/ijnns.0975.0223.10318.16.

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Morton, Ryan P., Brian W. Hanak, Michael R. Levitt, Kathleen R. Fink, Eric C. Peterson, Marcelo D. Vilela, Louis J. Kim, and Randall M. Chesnut. "Blunt traumatic occlusion of the internal carotid and vertebral arteries." Journal of Neurosurgery 120, no. 6 (June 2014): 1446–50. http://dx.doi.org/10.3171/2014.2.jns131658.

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Object The stroke rate, management, and outcome after blunt cerebrovascular occlusion (Biffl Grade IV injury) is not well defined, given the rarity of the disease. Both hemodynamic failure and embolic mechanisms have been implicated in the pathophysiology of subsequent stroke after blunt cerebrovascular occlusion. In this study, the authors evaluated their center's experience with Biffl Grade IV injuries, focusing on elucidating the mechanisms of stroke and their optimal management. Methods A retrospective review identified all internal carotid artery (ICA) or vertebral artery (VA) Biffl Grade IV injuries over a 7-year period at a single institution. Results Fifty-nine Biffl Grade IV injuries were diagnosed affecting 11 ICAs, 44 unilateral VAs, and 2 bilateral VAs. The stroke rates were 64%, 9%, and 50%, respectively. Of the 11 Biffl Grade IV ICA injuries, 5 presented with stroke while 2 developed delayed stroke. An ipsilateral posterior communicating artery greater than 1 mm on CT angiography was protective against stroke due to hemodynamic failure (p = 0.015). All patients with Biffl Grade IV injuries affecting the ICA who had at least 8 emboli per hour on transcranial Doppler (TCD) ultrasonography developed an embolic pattern of stroke (p = 0.006). Treatment with aspirin versus dual antiplatelet therapy had a similar effect on stroke rate in the ICA group (p = 0.5) and all patients who suffered stroke either died (n = 3) or required a decompressive hemicraniectomy with subsequent poor outcome (n = 4). All 10 strokes associated with Biffl Grade IV VA injuries were embolic and clinically asymptomatic. In VA Biffl Grade IV injury, neither the presence of emboli nor treatment with antiplatelet agents affected stroke rates. Conclusions At the authors' institution, traumatic ICA occlusion is rare but associated with a high stroke rate. Robust collateral circulation may mitigate its severity. Embolic monitoring with TCD ultrasonography and prophylactic antiplatelet therapy should be used in all ICA Biffl Grade IV injuries. Unilateral VA Biffl Grade IV injury is the most common type of traumatic occlusion and is associated with significantly less morbidity. Embolic monitoring using TCD and prophylactic antiplatelet therapy do not appear to be beneficial in patients with traumatic VA occlusion.

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Vanezis, P. "Vertebral Artery Injuries in Road Traffic Accidents: A Post-mortem Study." Journal of the Forensic Science Society 26, no. 4 (July 1986): 281–91. http://dx.doi.org/10.1016/s0015-7368(86)72496-1.

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Mittendorf, Elizabeth, Jeffrey M. Marks, Terri Berk, and Carlos Santoscoy. "Anomalous Vertebral Artery Anatomy and the Consequences of Penetrating Vascular Injuries." Journal of Trauma: Injury, Infection, and Critical Care 44, no. 3 (March 1998): 548–51. http://dx.doi.org/10.1097/00005373-199803000-00026.

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