Case Report

Vertebral Artery Anomaly Causing C2 Suboccipital Neuralgia, Relieved by Neurovascular Decompression

Christopher Trimble MD

From the Sacred Heart Medical Center – Transitional Year Residency Program, Spokane, Washington (CT); University of California, Irvine – Department of Neurosurgery, Orange, California (AR, LP); and University of California, Irvine – Department of Radiological Sciences, Orange, California (FT).

Search for more papers by this author

Alexa Reeves MD,

Alexa Reeves MD

Search for more papers by this author

Laura Pare MD,

Laura Pare MD

Search for more papers by this author

Fong Tsai MD,

Fong Tsai MD

Search for more papers by this author

Christopher Trimble MD,

Christopher Trimble MD

Search for more papers by this author

Alexa Reeves MD,

Alexa Reeves MD

Search for more papers by this author

Laura Pare MD,

Laura Pare MD

Search for more papers by this author

Fong Tsai MD,

Fong Tsai MD

Search for more papers by this author

First published: 17 June 2011

https://doi.org/10.1111/j.1552-6569.2011.00602.x

Citations: 2

Christopher Trimble, MD, Sacred Heart Medical Center – Transitional Year Residency Program 101 West Eighth Avenue, PO Box 2555, Spokane, WA 99220-2555, USA. E-mail: [email protected].

Conflict of Interest: None.

J Neuroimaging 2013;23:421-424.

Share a link

Email
Wechat
Bluesky

ABSTRACT

We report imaging and surgical findings of a symptomatic 40-year-old male with an anomalous left vertebral artery. MR, CT myelography, angiography, and intraoperative photos demonstrate the vertebral artery entering the thecal sac at the C1-C2 intervertebral foramen and compressing the dorsal C2 nerve rootlets against the cord. Open microvascular decompression alleviated the patient's long-standing suboccipital and posterior cervical neck pain. An embryologic review of the vertebral and lateral spinal artery systems reveals possible developmental explanations for this variant. Intradural course of the vertebral artery at C2 is one of the few symptomatic developmental vertebral artery anomalies. Recognition of this condition is important because surgical intervention can alleviate associated neck pain.

References

1 Sato K, Watanabe T, Yoshimoto T, et al. Magnetic resonance imaging of C2 segmental type of vertebral artery. Surg Neurol 1994; 41: 45–51.
10.1016/0090-3019(94)90207-0
CAS PubMed Web of Science® Google Scholar
2 Tokuda K, Miyasaka K, Abe H, et al. Anomalous atlantoaxial portions of vertebral and posterior inferior cerebellar arteries. Neuroradiology 1985; 27: 410–413.
10.1007/BF00327604
CAS PubMed Web of Science® Google Scholar
3 Sharma RR, Parekh HC, Prabhu S, et al. Compression of the C-2 root by a rare anomalous ectatic vertebral artery. Case report. J Neurosurg 1993; 78: 669–672.
10.3171/jns.1993.78.4.0669
CAS PubMed Web of Science® Google Scholar
4 Watanabe K, Hasegawa K, Takano K. Anomalous vertebral artery-induced cervical cord compression causing severe nape pain. Case report. J Neurosurg 2001; 95: 146–149.
10.3171/spi.2001.95.1.0146
CAS PubMed Web of Science® Google Scholar
5 Satoh S, Yamamoto N, Kitagawa Y, et al. Cervical cord compression by the anomalous vertebral artery presenting with neuralgic pain. Case report. J Neurosurg 1993; 79: 283–285.
10.3171/jns.1993.79.2.0283
CAS PubMed Web of Science® Google Scholar
6 Takahashi Y, Sugita S, Uchikado H, et al. Cervical myelopathy due to compression by bilateral vertebral arteries–case report. Neurol Med Chir 2001; 41: 322–324.
10.2176/nmc.41.322
CAS PubMed Web of Science® Google Scholar
7 Siclari F, Burger IM, Fasel JH, et al. Developmental anatomy of the distal vertebral artery in relationship to variants of the posterior and lateral spinal arterial systems. AJNR Am J Neuroradiol 2007; 28: 1185–1190.
10.3174/ajnr.A0498
CAS PubMed Web of Science® Google Scholar
8 Parkinson D, Reddy V, Ross RT. Congenital anastomosis between the vertebral artery and internal carotid artery in the neck. Case report. J Neurosurg 1979; 51: 697–699.
10.3171/jns.1979.51.5.0697
CAS PubMed Web of Science® Google Scholar
9 Lasjaunias P, Vallee B, Person H, et al. The lateral spinal artery of the upper cervical spinal cord. Anatomy, normal variations, and angiographic aspects. J Neurosurg 1985; 63: 235–241.
10.3171/jns.1985.63.2.0235
CAS PubMed Web of Science® Google Scholar
10 Lasjaunias P, Braun J, Hasso A, et al. True and false fenestration of the vertebral artery. J Neuroradiol 1980; 7: 157–166.
CAS PubMed Web of Science® Google Scholar
11 Vincentelli F, Caruso G, Rabehanta PB, et al. Surgical treatment of a rare congenital anomaly of the vertebral artery: case report and review of the literature. Neurosurgery 1991; 28: 416–420.
CAS PubMed Web of Science® Google Scholar
12 Giuffre R, Sherkat S. Maldevelopmental pathology of the vertebral artery in infancy and childhood. Childs Nerv Syst 2000; 16: 627–632.
10.1007/PL00013718
CAS PubMed Web of Science® Google Scholar
13 Rogers LA. Acute subdural hematoma and death following lateral cervical spinal puncture. Case report. J Neurosurg 1983; 58: 284–286.
10.3171/jns.1983.58.2.0284
CAS PubMed Web of Science® Google Scholar
14 Takei H, Sagae M, Chiba K, et al. 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 2008; 33: E611–E613.
10.1097/BRS.0b013e31817c6c17
PubMed Web of Science® Google Scholar

Citing Literature

Volume23, Issue3

July 2013

Pages 421-424

Vertebral Artery Anomaly Causing C2 Suboccipital Neuralgia, Relieved by Neurovascular Decompression

ABSTRACT

References

Citing Literature

References

Information

About Wiley Online Library

Help & Support

Opportunities

Connect with Wiley

Vertebral Artery Anomaly Causing C2 Suboccipital Neuralgia, Relieved by Neurovascular Decompression

ABSTRACT

References

Citing Literature

References

Related

Information