Neurointervention.  2018 Mar;13(1):62-65. 10.5469/neuroint.2018.13.1.62.

MRI Vessel Wall Imaging and Treatment of an Aneurysm at the Atlanto-Axial Segment of an Aberrant Vertebral Artery

• Anderson T
• Ryo YW
• Fung MK
• Man LW

• KMID: 2424052
• DOI: http://doi.org/10.5469/neuroint.2018.13.1.62

Abstract

We report a case of unique location of an aneurysm at the atlanto-axial extradural segment of a unilateral aberrant vertebral artery. The MRI vessel wall imaging findings and possible mechanism of aneurysm formation were discussed. A 5 mm extracranial vertebral artery aneurysm located at the interlaminar space between C1 and C2 was diagnosed in a woman presenting with occipital headache. The index vertebral artery ran an aberrant course at the V3 segment, where it entered the dura between C1 and C2 instead of the usual atlanto-occipital space. MR vessel wall imaging showed homogenous wall enhancement of the aneurysm sac. We surmise the anomalous course of the vertebral artery subjected the V3 segment to repeated shearing force secondary to the atlanto-axial rotational neck movement. This led to vessel wall trauma and inflammation, and subsequent aneurysm formation. The aneurysm was successfully treated with endovascular coiling with resolution of symptoms.

Keyword

Vessel wall imaging; Aneurysm; Vertebral artery

MeSH Terms

Aneurysm*
Female
Headache
Humans
Inflammation
Magnetic Resonance Imaging*
Neck
Vertebral Artery*

Figure

• 

  Fig. 1 Catheter angiogram with left vertebral artery injection. (A) Anteroposterior view showing a 5mm saccular aneurysm (arrow) at the extra-dural segment of the vertebral artery. (B) Lateral projection angiogram with fluoroscopy overlay showing the aneurysm (arrow) located at the atlantoaxial level.

• 

  Fig. 2 Coronal MRI showing the aberrant left vertebral artery with the aneurysm located between the left atlas and axis (arrow). (A) PD VISTA and (B) T1-weighted with gadolinium contrast sequence showing circumferential aneurysm wall enhancement. Note the right vertebral artery followed the usual course above the atlas (arrowhead).

• 

  Fig. 3 (A) Control left vertebral artery subtraction angiogram showing its aberrant course, and complete exclusion of aneurysm from the circulation after coil embolization. (B) Lateral projection of the same left vertebral artery angiogram with fluoroscopy overlay. The aneurysm coil mass is located at the interlaminar space between C1 and C2.

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