Abstract
We report a case of anomalous vertebral arteries with compression of the upper cervical cord. A 58-year-old man complained of a sharp and stabbing pain in the left suboccipital region and tingling sensation in his left upper limb and shoulder. Neurological examination on admission showed no definite abnormality. Cervical MRI showed a flow void in the spinal canal at the level of the atlas. Vertebral angiography and 3D-CT angiography showed that the bilateral vertebral arteries had penetrated the dura mater below the posterior arch of the atlas in the atolantoaxial interlaminar space. We diagnosed the symptoms as due to the anomalous vertebral arteries. Cl and C2 laminectomy was performed in the prone position. Postoperative course was uneventful, but the same pain occurred one year later. Three and a half years after the operation, the degree and frequency of the pain was one third of the primary pain. A review of the literature and the findings from our case revealed that transposition of the anomalous vertebral arteries by surgery should be performed for complete relief from the symptoms.
