Skip Navigation LinksHome > December 2013 - Volume 73 - Issue > Multimodality Management of Vertebral Artery Injury Sustaine...
doi: 10.1227/01.neu.0000431468.74591.5f

Multimodality Management of Vertebral Artery Injury Sustained During Cervical or Craniocervical Surgery

Maughan, Peter Hanks MD; Ducruet, Andrew F. MD; Elhadi, Ali M. MD; Martirosyan, Nikolay L. MD; Garrett, Mark MD; Mushtaq, Raza BA; Albuquerque, Felipe C. MD; Theodore, Nicholas MD, FACS

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BACKGROUND: Iatrogenic vertebral artery (VA) injury is a rare but potentially devastating complication associated with cervical and craniocervical surgery.

OBJECTIVE: To retrospectively evaluate treatment modalities and outcomes associated with iatrogenic VA injury.

METHODS: Our institutional surgical database was queried for patients who underwent cervical or craniocervical surgery from January 1997 to August 2012.

RESULTS: During this time period, 8213 patients underwent cervical or craniocervical surgery, and 17 (0.2%) cases of VA injury were identified. Eight (47%) of these injuries occurred during C1-2 instrumentation procedures. Primary microsurgical repair of the VA was performed in 5 patients. Other cases were managed by either surgical or endovascular VA occlusion. Of the 17 patients, 15 underwent immediate angiography, 9 of whom were ultimately treated by the use of endovascular techniques.

CONCLUSION: VA injury is an uncommon complication of cervical and/or skull base surgery. Standardized management recommendations may help reduce complications associated with these rare but potentially devastating injuries.

ABBREVIATIONS: ACDFP, anterior cervical discectomy with fusion and plating

CTA, computed tomography angiography

PICA, posterior inferior cerebellar artery

POD, postoperative day

SAH, subarachnoid hemorrhage

VA, vertebral artery

Copyright © by the Congress of Neurological Surgeons


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