OA–V3 bypass prevented cerebral ischemia during the peri–operative period: A case report

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  • 後頭動脈—頭蓋外椎骨動脈吻合術を施行し周術期脳虚血を予防しえた１例
  • 後頭動脈-頭蓋外椎骨動脈吻合術を施行し周術期脳虚血を予防しえた1例
  • コウトウ ドウミャク-ズガイ ガイ ツイコツ ドウミャク フンゴウジュツ オ シコウ シ シュウジュツキ ノウキョケツ オ ヨボウ シエタ 1レイ

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Abstract

<p>  Revascularization of the posterior circulatory system is relatively rare, and that using the extracranial vertebral artery as a recipient is extremely rare. We performed an occipital artery (OA)‒V3 bypass on a patient with symptomatic intracranial vascular stenosis before cervical posterior fusion, and the patient showed no new neurological abnormalities during the peri‒operative period. The patient was a Japanese male in his 30s, and he had experienced weakness in his right lower limb while walking for ～1 year. He visited a local physician after his symptoms had worsened for the prior month, and the physician noted a cervical spine injury and referred him to our hospital. We observed mild paralysis of the right lower limb and extremity tendon hyper‒reflexia. Cervical spine MRI showed intramedullary hyperintensity from the cranio‒cervical spine transition to C2 on T2‒weighted images. Cervical spine CT showed os odontoideum, atlanto occipital dislocation (AOD), and atlantoaxial dislocation (AAD). Posterior cervical spine fusion (CO‒C2 fixation) was deemed necessary due to the patient’s progressive myelopathy. However, head MRA revealed stenosis of the vertebrobasilar artery; in addition, head MRI T2‒weighted images revealed old infarctions in the bilateral cerebellar hemisphere, left pons, and left thalamus. Head and neck CT showed bilateral vertebral arteries, but the left vertebral artery was occluded at the C2 level. Angiography showed that the left deep carotid artery had developed compensatorily and was anastomosed with the left vertebral artery at the C2 level. When posterior cervical spine fusion is performed, the collateral circulation to the left vertebral artery running through the muscular layer may become blocked, resulting in peri‒operative cerebral ischemia. We therefore performed the OA‒V3 bypass first, and the posterior cervical fusion was performed at a later date. The patient was discharged from the hospital with no peri‒operative neurological dropout findings.</p>

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