Neurosurgery and Spine Surgery

Abnormal vertebral artery, not passing through C1 foramen, contacting c2 nerve

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  • tomhammo
    Participant

      Patient with rare abnormal left vertebral artery (VA), which courses under the posterior arch of the atlas after exiting the C2 transverse foramen (without passing through the C1 transverse foramen) and enters the spinal canal between C1 and C2, where it contacts the exiting C2 nerve (see blue dot in video) – being a likely cause for severe and chronic neck and occipital pain.

      This is referred to in the literature as ‘persistent first intersegmental artery’ or ‘C2 segmental type vertebral artery’ or ‘inverted vertebral artery, V3 segment’.

      Seeking information and help regarding potential surgical options to resolve contact between artery and the left C2 nerve (see blue dot in video) to resolve the chronic pain, and to investigate potential spinal cord or medulla compression to help find the cause for trigeminal neuralgia.

      Left abnormal vertebral artery contact C2 nerve

      • This topic was modified 2 weeks, 2 days ago by tomhammo.
      tomhammo
      Participant

        Left abnormal vertebral artery contacting c2 nerve

        tomhammo
        Participant

          … had difficulty inserting the video into my original post above… see link below for video…

          Link to video of abnormal vertebral artery contacting c2 nerve (blue dot in center is point of contact)

          • This reply was modified 2 weeks, 2 days ago by tomhammo.
          tomhammo
          Participant

            … above link doesn’t work… see link below for video…

            Link to video of abnormal vertebral artery contacting c2 nerve (blue dot in center is point of contact)

            • This reply was modified 2 weeks ago by tomhammo.
            Dr Sandeep
            Keymaster

              The treatment in Microvascular decompression by either a teflon patch or by transposing the artery away. Please check out this case report:

              https://bmcneurol.biomedcentral.com/articles/10.1186/s12883-020-01976-x

              tomhammo
              Participant

                Thank you very much.

                Would you have any recommendations for what type of dynamic imaging might be useful to assess potential compression of the spinal cord or medulla during head movement, given the tight intradural path of the vertebral artery around the spinal cord?

                Dr Sandeep
                Keymaster

                  For this you can get any of these –

                  X ray CVJ Flexion and Extension
                  -Dynamic NCCT Flexion and Extension
                  https://pubmed.ncbi.nlm.nih.gov/17538278/
                  -Dynamic MRI flexion and extension https://pubmed.ncbi.nlm.nih.gov/17538278/

                  • This reply was modified 3 days, 17 hours ago by Dr Sandeep.
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