Bilateral persistent 'second' intersegmental vertebral arteries: illustrated with a case. 2018

Madhivanan Karthigeyan, and Pravin Salunke, and Mandeep Singh Kataria
Department of Neurosurgery, Postgraduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh, 160012, India. karthigeyanm82@gmail.com.

Congenital craniovertebral junction deformities can be associated with an anomalous vertebral artery (VA). At times, the artery crosses the joint posteriorly (i.e., persistent first intersegmental artery) and is at risk during posterior approach. We report a new variant, wherein the bilateral VA coursed medially after exiting the C3 transverse foramina to lie beneath C2 pars interarticularis and enter the foramen magnum (without passing through C2 transverse foramen anywhere along its course). This is possibly a result of bilateral persistent second intersegmental arteries. It is pertinent to recognize this unusual variant to avoid VA injury, especially while inserting C2 pars/transarticular screw.

UI MeSH Term Description Entries
D002648 Child A person 6 to 12 years of age. An individual 2 to 5 years old is CHILD, PRESCHOOL. Children
D004204 Joint Dislocations Displacement of bones from their normal positions at a joint. Inferior Dislocation,Joint Subluxations,Luxatio Erecta,Dislocation, Joint,Dislocations, Joint,Inferior Dislocations,Joint Dislocation,Joint Subluxation,Subluxation, Joint,Subluxations, Joint
D005260 Female Females
D005539 Foramen Magnum The large hole at the base of the skull through which the SPINAL CORD passes. Foramen Magnums,Magnum, Foramen,Magnums, Foramen
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D001268 Atlanto-Axial Joint The joint involving the CERVICAL ATLAS and axis bones. Atlanto Axial Joint,Atlantoaxial Joint,Atlanto Axial Joints,Atlanto-Axial Joints,Atlantoaxial Joints,Joint, Atlanto Axial,Joint, Atlanto-Axial,Joint, Atlantoaxial,Joints, Atlanto Axial,Joints, Atlanto-Axial,Joints, Atlantoaxial
D001270 Cervical Atlas The first cervical vertebra. Atlas, Cervical,Arcuate Foramen,C1 Vertebra,Kimmerle Anomaly,Ponticulus Posterior of the Atlas,Ponticulus Posticus,Anomaly, Kimmerle,C1 Vertebras,Vertebra, C1,Vertebras, C1
D013123 Spinal Fusion Operative immobilization or ankylosis of two or more vertebrae by fusion of the vertebral bodies with a short bone graft or often with diskectomy or laminectomy. (From Blauvelt & Nelson, A Manual of Orthopaedic Terminology, 5th ed, p236; Dorland, 28th ed) Spondylodesis,Spondylosyndesis,Fusion, Spinal,Fusions, Spinal,Spinal Fusions,Spondylodeses,Spondylosyndeses
D014711 Vertebral Artery The first branch of the SUBCLAVIAN ARTERY with distribution to muscles of the NECK; VERTEBRAE; SPINAL CORD; CEREBELLUM; and interior of the CEREBRUM. Vertebral Arteries,Arteries, Vertebral,Artery, Vertebral

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