Browse > Article
http://dx.doi.org/10.3340/jkns.2012.51.3.177

Intraoperative Vertebral Artery Angiography to Guide C1-2 Transarticular Screw Fixation in a Patient with Athetoid Cerebral Palsy  

Chung, Jong-Chul (Department of Neurosurgery, Eulji University Hospital)
Jung, Sung-Sam (Department of Neurosurgery, Eulji University Hospital)
Park, Ki-Seok (Department of Neurosurgery, Eulji University Hospital)
Ha, Ho-Gyun (Department of Neurosurgery, Konyang University Hospital)
Publication Information
Journal of Korean Neurosurgical Society / v.51, no.3, 2012 , pp. 177-181 More about this Journal
Abstract
We present a case of an athetoid cerebral palsy with quadriparesis caused by kyphotic deformity of the cervical spine, severe spinal stenosis at the cervicomedullary junction, and atlantoaxial instability. The patient improved after the first surgery, which included a C1 total laminectomy and C-arm guided righ side unilateral C1-2 transarticular screw fixation. C1-2 fixation was not performed on the other side because of an aberrant and dominant vertebral artery (VA). Eight months after the first operation, the patient required revision surgery for persistent neck pain and screw malposition. We used intraoperative VA angiography with simultaneous fluoroscopy for precise image guidance during bilateral C1-2 transarticular screw fixation. Intraoperative VA angiography allowed the accurate insertion of screws, and can therefore be used to avoid VA injury during C1-2 transarticular screw fixation in comorbid patients with atlantoaxial deformities.
Keywords
Atlantoaxial instability; Transarticular screw fixation; Vertebral artery; Intraoperative angiography; Athetoid cerebral palsy;
Citations & Related Records
Times Cited By KSCI : 1  (Citation Analysis)  (Related Records In Web of Science)
연도 인용수 순위
1 Mihara F, Yoshiura T, Noguchi T, Togao O, Morioka T, Sasaki T, et al. : A method to reduce saline and heparin in intraoperative cerebral angiography : a preliminary report. Radiat Med 23 : 588-589, 2005
2 Neo M, Matsushita M, Yasuda T, Sakamoto T, Nakamura T : Use of an aiming device in posterior atlantoaxial transarticular screw fixation. Technical note. J Neurosurg 97 : 123-127, 2002
3 Onari K, Kondo S, Mihara H, Iwamura Y : Combined anterior-posterior fusion for cervical spondylotic myelopathy in patients with athetoid cerebral palsy. J Neurosurg 97 : 13-19, 2002
4 Richter M, Mattes T, Cakir B : Computer-assisted posterior instrumentation of the cervical and cervico-thoracic spine. Eur Spine J 13 : 50-59, 2004   DOI   ScienceOn
5 Schievink WI, Vishteh AG, McDougall CG, Spetzler RF : Intraoperative spinal angiography. J Neurosurg 90 : 48-51, 1999
6 Song GS, Theodore N, Dickman CA, Sonntag VK : Unilateral posterior atlantoaxial transarticular screw fixation. J Neurosurg 87 : 851-855, 1997   DOI   ScienceOn
7 Tokuda K, Miyasaka K, Abe H, Abe S, Takei H, Sugimoto S, et al. : Anomalous atlantoaxial portions of vertebral and posterior inferior cerebellar arteries. Neuroradiology 27 : 410-413, 1985   DOI   ScienceOn
8 Tsirikos AI, Chang WN, Shah SA, Miller F : Acquired atlantoaxial instability in children with spastic cerebral palsy. J Pediatr Orthop 23 : 335-341, 2003
9 Wright NM, Lauryssen C : Vertebral artery injury in C1-2 transarticular screw fixation : results of a survey of the AANS/CNS section on disorders of the spine and peripheral nerves. American Association of Neurological Surgeons/Congress of Neurological Surgeons. J Neurosurg 88 : 634-640, 1998   DOI   ScienceOn
10 Yamazaki M, Koda M, Aramomi MA, Hashimoto M, Masaki Y, Okawa A : Anomalous vertebral artery at the extraosseous and intraosseous regions of the craniovertebral junction : analysis by three-dimensional computed tomography angiography. Spine (Phila Pa 1976) 30 : 2452-2457, 2005   DOI   ScienceOn
11 Yoshida M, Neo M, Fujibayashi S, Nakamura T : Comparison of the anatomical risk for vertebral artery injury associated with the C2-pedicle screw and atlantoaxial transarticular screw. Spine (Phila Pa 1976) 31 : E513-E517, 2006   DOI   ScienceOn
12 Azuma S, Seichi A, Ohnishi I, Kawaguchi H, Kitagawa T, Nakamura K : Long-term results of operative treatment for cervical spondylotic myelopathy in patients with athetoid cerebral palsy : an over 10-year follow-up study. Spine (Phila Pa 1976) 27 : 943-948; discussion 948, 2002   DOI   ScienceOn
13 Duan S, He H, Lv S, Chen L : Three-dimensional CT study on the anatomy of vertebral artery at atlantoaxial and intracranial segment. Surg Radiol Anat 32 : 39-44, 2010   DOI   ScienceOn
14 Duruflé A, Pétrilli S, Le Guiet JL, Brassier G, Nicolas B, Le Tallec H, et al. : Cervical spondylotic myelopathy in athetoid cerebral palsy patients : about five cases. Joint Bone Spine 72 : 270-274, 2005   DOI   ScienceOn
15 Haid RW Jr : C1-C2 transarticular screw fixation : technical aspects. Neurosurgery 49 : 71-74, 2001
16 Haro H, Komori H, Okawa A, Shinomiya K : Surgical treatment of cervical spondylotic myelopathy associated with athetoid cerebral palsy. J Orthop Sci 7 : 629-636, 2002   DOI   ScienceOn
17 Hirose G, Kadoya S : Cervical spondylotic radiculo-myelopathy in patients with athetoid-dystonic cerebral palsy : clinical evaluation and surgical treatment. J Neurol Neurosurg Psychiatry 47 : 775-780, 1984   DOI
18 Laherty RW, Kahler RJ, Walker DG, Tomlinson FH : Stereotactic atlantoaxial transarticular screw fixation. J Clin Neurosci 12 : 62-65, 2005   DOI   ScienceOn
19 Hue YH, Chun HJ, Yi HJ, Oh SH, Oh SJ, Ko Y : Unilateral posterior atlantoaxial transarticular screw fixation in patients with atlantoaxial instability : comparison with bilateral method. J Korean Neurosurg Soc 45 : 164-168, 2009   DOI
20 Kawaguchi Y, Ishihara H, Ohmori K, Kanamori M, Kimura T : Computer-assisted Magerl's transarticular screw fixation for atlantoaxial subluxation. J Orthop Sci 7 : 131-136, 2002   DOI   ScienceOn
21 Lang SS, Eskioglu E, A Mericle R : Intraoperative angiography for neurovascular disease in the prone or three-quarter prone position. Surg Neurol 65 : 283-289; discussion 289, 2006   DOI   ScienceOn
22 Madawi AA, Casey AT, Solanki GA, Tuite G, Veres R, Crockard HA : Radiological and anatomical evaluation of the atlantoaxial transarticular screw fixation technique. J Neurosurg 86 : 961-968, 1997   DOI   ScienceOn