Abstract
The objective of this article is to display the vertebral artery and bone structure at the craniocervical junction (CJVA and C0-1-2) with three-dimensional CT angiography (3DCTA) and identify their anatomic features and variations. Eighty-eight subjects without pathology of vertebral artery (VA) and C0-1-2 were selected from head–neck CTA examination. 3D images were formed with volume rendering (VR) and multiplanar reconstruction (MPR). On the 3D images, CJVA and C0-1-2 were measured, and their variations were observed. CJVA goes along C0-1-2 with five curves, of which three curves are visibly away from C0-1-2, one is 0.0–8.3 mm away at the second curve with 0.0–11.2 mm in width, another is 0.0–9.2 mm away at the fourth with 2.8–14.8 mm and the other is 0.0–6.2 mm away at the fifth. Statistical comparisons show that there is no significant difference in the measurements between left and right, and that the curves become smaller and farther away from C0-1-2 with the increase of age. CJVA is not equal in size, with the biggest in the fourth curve and the smallest in the fifth. Statistical comparison shows the left CJVA is larger than the right in the fifth curve. Variations were found on CJVA in 16 cases and on C1 in 12 cases. The anatomy and variations of CJVA and C0-1-2 are complicated. It is of vital significance to identify their anatomic features in clinical practice.
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Bruneau M, Cornelius JF, George B (2006) Antero-lateral approach to the V3 segment of the vertebral artery. Neurosurgery 58:29–35
Cacciola F, Phalke U, Goel A (2004) Vertebral artery in relationship to C1–C2 vertebrae: an anatomical study. Neurol India 52:178–184
Duan SY, Huang XE, Lin QC, Chen GN (2007) Clinical significance of articulating facet displacement of lateral atlantoaxial joint on 3D CT in diagnosing atlantoaxial subluxation. J Formos Med Assoc 106:840–846. doi:10.1016/S0929-6646(08)60049-2
Duan SY, Ye F, Kang JH (2007) Three-dimensional CT study on normal anatomical features of atlanto-axial joints. Surg Radiol Anat 29:83–88. doi:10.1007/s00276-006-0166-0
Hong JT, Lee SW, Son BC, Sung JH, Yang SH, Kim IS, Park CK (2008) Analysis of anatomical variations of bone and vascular structures around the posterior atlantal arch using three-dimensional computed tomography angiography. J Neurosurg Spine 8:230–236. doi:10.3171/SPI/2008/8/3/230
Huynh-Le P, Matsushima T, Miyazono M, Sayama T, Muratani H, Tashima T, Sasaki T (2004) Three-dimensional CT angiography for the surgical management of the vertebral artery-posterior inferior cerebellar artery aneurysms. Acta Neurochir (Wien) 146:329–335. doi:10.1007/s00701-003-0157-4
Lell MM, Ditt H, Panknin C, Sayre JW, Klotz E, Ruehm SG, Villablanca JP (2008) Cervical CT angiography comparing routine noncontrast and a late venous scan as masks for automated bone subtraction: feasibility study and examination of the influence of patient motion on image quality. Invest Radiol 43:27–32. doi:10.1097/RLI.0b013e31815597ac
Malhotra AK, Camacho M, Ivatury RR, Davis IC, Komorowski DJ, Leung DA, Grizzard JD, Aboutanos MB, Duane TM, Cockrell C, Wolfe LG, Borchers CT, Martin NR (2007) Computed tomographic angiography for the diagnosis of blunt carotid/vertebral artery injury: a note of caution. Ann Surg 246:632–643. doi:10.1097/SLA.0b013e3181568cab
Moftakhar P, Gonzalez NR, Khoo LT, Holly LT (2008) Osseous and vascular anatomical variations within the C1–C2 complex: a radiographical study using computed tomography angiography. Int J Med Robot 4:158–164. doi:10.1002/rcs.193
Neo M, Matsushita M, Iwashita Y, Yasuda T, Sakamoto T, Nakamura T (2003) Atlantoaxial transarticular screw fixation for a high-riding vertebral artery. Spine 28:666–670. doi:10.1097/00007632-200304010-00009
Petridis AK, Barth H, Buhl R, Mehdorn HM (2008) Vertebral artery decompression in a patient with rotational occlusion. Acta Neurochir (Wien) 150:391–394. doi:10.1007/s00701-008-1502-4
Pugliese F, Crusco F, Cardaioli G, Tambasco N, Boranga B, Scaroni R, Maselli A, Lupattelli L (2007) CT angiography versus colour-Doppler US in acute dissection of the vertebral artery. Radiol Med (Torino) 112:435–443. doi:10.1007/s11547-007-0152-6
Puchner S, Haumer M, Rand T, Reiter M, Minar E, Lammer J, Bucek RA (2007) CTA in the detection and quantification of vertebral artery pathologies: a correlation with color Doppler sonography. Neuroradiology 49:645–650. doi:10.1007/s00234-007-0234-0
Ren X, Wang W, Zhang X, Pu Y, Jiang T, Li C (2007) Clinical study and comparison of magnetic resonance angiography (MRA) and angiography diagnosis of blunt vertebral artery injury. J Trauma 63:1249–1253
Sparacia G, Bencivinni F, Banco A, Sarno C, Bartolotta TV, Lagalla R (2007) Imaging processing for CT angiography of the cervicocranial arteries: evaluation of reformatting technique. Radiol Med (Torino) 112:224–238. doi:10.1007/s11547-007-0137-5
Sawlani V, Behari S, Salunke P, Jain VK, Phadke RV (2006) “Stretched loop sign” of the vertebral artery: a predictor of vertebrobasilar insufficiency in atlantoaxial dislocation. Surg Neurol 66:298–304. doi:10.1016/j.surneu.2006.02.032
Sylaja PN, Puetz V, Dzialowski I, Krol A, Hill MD, Demchuk AM (2008) Prognostic value of CT angiography in patients with suspected vertebrobasilar ischemia. J Neuroimaging 18:46–49
Senoglu M, Safavi-Abbasi S, Theodore N, Bambakidis NC, Crawford NR, Sonntag VK (2007) The frequency and clinical significance of congenital defects of the posterior and anterior arch of the atlas. J Neurosurg Spine 7:399–402. doi:10.3171/SPI-07/10/399
Sanelli PC, Tong S, Gonzalez RG, Eskey CJ (2002) Normal variation of vertebral artery on CT angiography and its implications for diagnosis of acquired pathology. J Comput Assist Tomogr 26:462–670. doi:10.1097/00004728-200205000-00027
Tubbs RS, Johnson PC, Shoja MM, Loukas M, Oakes WJ (2007) Foramen arcuale: anatomical study and review of the literature. J Neurosurg Spine 6:31–34. doi:10.3171/spi.2007.6.1.6
Utter GH, Hollingworth W, Hallam DK, Jarvik JG, Jurkovich GJ (2006) Sixteen-slice CT angiography in patients with suspected blunt carotid and vertebral artery injuries. J Am Coll Surg 203:838–848. doi:10.1016/j.jamcollsurg.2006.08.003
Yamazaki M, Koda M, Aramomi MA, Hashimoto M, Masaki Y, Okawa A (2005) Anomalous vertebral artery at the extraosseous and intraosseous regions of the craniovertebral junction: analysis by three-dimensional computed tomography angiography. Spine 30:2452–2457. doi:10.1097/01.brs.0000184306.19870.a8
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We would like to thank the sustentation from the Fund of **amen City’s Scientific and Technical Program (3502Z 20064008) and National Natural Science Foundation (30870690), China.
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Duan, S., Lv, S., Ye, F. et al. Imaging anatomy and variation of vertebral artery and bone structure at craniocervical junction. Eur Spine J 18, 1102–1108 (2009). https://doi.org/10.1007/s00586-009-0925-9
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DOI: https://doi.org/10.1007/s00586-009-0925-9