J Korean Neurosurg Soc.  2013 Oct;54(4):347-349. 10.3340/jkns.2013.54.4.347.

Cervical Compressive Myelopathy due to Anomalous Bilateral Vertebral Artery

• Ha EJ
• Lee SE
• Jahng TA
• Kim HJ

• KMID: 1499343
• DOI: http://doi.org/10.3340/jkns.2013.54.4.347

Abstract

We report a very rare case of cervical compressive myelopathy by an anomalous bilateral vertebral artery (VA) entering the spinal canal at the C1 level and compressing the spinal cord. A 70-year-old woman had been suffering from progressive gait disturbance. Magnetic resonance imaging revealed that a bilateral VA at the V4 segment had abnormal courses and caused compression to the high cervical cord. VA repositioning was performed by anchoring a suture between the artery and around the arachnoid membrane and dentate ligament, and then, microvascular decompression using a Teflon sponge was done between the VA and the spinal cord. The weakness in the patient improved in the lower extremity after the operation. Anomalous VA could be one of the rare causes of cervical compressive myelopathy. Additionally, an anchoring suture and microvascular decompression around the VA could be a sufficient and safe method to indirectly decompress the spinal canal.

Keyword

Vertebral artery anomaly; Cervical myelopathy; Microvascular decompression

MeSH Terms

Aged
Arachnoid
Arteries
Female
Gait
Humans
Ligaments
Lower Extremity
Magnetic Resonance Imaging
Membranes
Microvascular Decompression Surgery
Polytetrafluoroethylene
Porifera
Spinal Canal
Spinal Cord
Spinal Cord Compression*
Sutures
Vertebral Artery*
Polytetrafluoroethylene

Figure

• 

  Fig. 1 A : Preoperative MRI. Midsagittal T2-weighted image shows a signal void region (arrow) at the C1 level. B : Axial T2-weighted image shows the compression of the spinal cord in the bilateral posterolateral region.

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  Fig. 2 Preoperative CT angiography shows a medially looped bilateral VA and has a kissing appearance at the C1 level.

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  Fig. 3 Immediate postoperative CT angiography shows the bilateral VAs separated from each other without interruption in the blood flow at the C1 level.

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  Fig. 4 Postoperative axial T2-weighted image shows the recovery of the spinal cord contour and the laterally transposed VA 6 months after the operation.

Reference

1. Furumoto T, Nagase J, Takahashi K, Itabashi T, Iai H, Ishige N. Cervical myelopathy caused by the anomalous vertebral artery. A case report. Spine (Phila Pa 1976). 1996; 21:2280–2283. PMID: 8902976.

2. Goel A, Shah A. Trigeminal neuralgia in the presence of ectatic basilar artery and basilar invagination : treatment by foramen magnum decompression. J Neurosurg. 2009; 111:1220–1222. PMID: 19558301.

3. Hasegawa T, Kubota T, Ito H, Yamamoto S. Symptomatic duplication of the vertebral artery. Surg Neurol. 1983; 20:244–248. PMID: 6879426.

4. Jannetta PJ. Observations on the etiology of trigeminal neuralgia, hemifacial spasm, acoustic nerve dysfunction and glossopharyngeal neuralgia. Definitive microsurgical treatment and results in 117 patients. Neurochirurgia (Stuttg). 1977; 20:145–154. PMID: 198692.

5. Satoh S, Yamamoto N, Kitagawa Y, Umemori T, Sasaki T, Iida T. Cervical cord compression by the anomalous vertebral artery presenting with neuralgic pain. Case report. J Neurosurg. 1993; 79:283–285. PMID: 8331414.

6. Suzuki S, Tsuchita H, Kurokawa Y, Kitami K, Sohma T, Takeda T. New method of MVD using a vascular tape for neurovascular compression involving the vertebrobasilar artery--report of two cases. Neurol Med Chir (Tokyo). 1990; 30:1020–1023. PMID: 1714048.

7. Takahashi T, Tominaga T, Hassan T, Yoshimoto T. Cervical cord compression with myelopathy caused by bilateral persistence of the first intersegmental arteries : case report. Neurosurgery. 2003; 53:234–237. discussion 237. PMID: 12823896.

8. Takahashi Y, Sugita S, Uchikado H, Miyagi T, Tokutomi T, Shigemori M. Cervical myelopathy due to compression by bilateral vertebral arteries--case report. Neurol Med Chir (Tokyo). 2001; 41:322–324. PMID: 11458746.

9. Takei H, Sagae M, Chiba K, Ogino T. The long-term follow-up of surgical treatment for cervical myelopathy with severe nape and upper arm pain caused by the anomalous vertebral artery : case report. Spine (Phila Pa 1976). 2008; 33:E611–E613. PMID: 18670330.

10. Tokuda K, Miyasaka K, Abe H, Abe S, Takei H, Sugimoto S, et al. Anomalous atlantoaxial portions of vertebral and posterior inferior cerebellar arteries. Neuroradiology. 1985; 27:410–413. PMID: 4058734.

11. Watanabe K, Hasegawa K, Takano K. Anomalous vertebral artery-induced cervical cord compression causing severe nape pain. Case report. J Neurosurg. 2001; 95(1 Suppl):146–149. PMID: 11453419.