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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

doi: 10.1227/01.neu.0000431468.74591.5f

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

Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona

Correspondence: Nicholas Theodore, MD, FACS, c/o Neuroscience Publications, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 350 W Thomas Rd, Phoenix, AZ 85013, E-mail:

Received November 28, 2012

Accepted April 23, 2013

Copyright © by the Congress of Neurological Surgeons