The retrospective analysis of dangerous anatomical and functional variations of V3 segment of vertebral artery in 834 patients with central nervous system diseases

Abstract

Objective To study the dangerous variations of vertebral artery (VA) at craniovertebral junction (V3 segment). Methods The imaging data of 834 patients who underwent DSA in Jining No.1 People's Hospital from January 2019 to October 2020 were collected, the incidences of dangerous anatomical variation and dangerous functional variation of persistent first intersegmental artery, VA fenestration, posterior inferior cerebellar artery (PICA) with lower origin, dominant VA and terminating PICA were analyzed. Results The variation of V3 segment of VA was divided into dangerous anatomical variation and dangerous functional variation. Dangerous anatomic variation included persistent first intersegmental vertebral artery, VA fenestration and PICA with lower origin. The incidence of the three types of unilateral dangerous anatomical variation was 1.92% (17/834), 1.80% (16/834) and 1.68 (15/834). The incidence of bilateral dangerous anatomical variation was 0.12% (1/834), while one side of the VA was fenestrated and the other side was the persistent first intersegmental artery. Dangerous functional variation included dominant VA and terminating PICA. The incidence of these two functional variation was 13.19% (110/834) and 3.72% (31/834). The left dominant VA was more common (79.09%, 87/110), while the right was 23 cases (20.91%, 23/110). Thirty⁃one cases (3.72%, 31/834) of terminating PICA, while 26 cases (83.87%, 26/31) in the right and 5 cases (16.13%, 5/31) in the left. Conclusions The incidence of dangerous variation in V3 segment of VA is high. Imaging dangerous anatomical variation and dangerous functional variation should be routinely performed before craniovertebral junction surgery to evaluate the possible VA examinations variation patients, so as to reduce the risk of VA injury during surgery.

doi：10.3969/j.issn.1672⁃6731.2022.08.004