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