2014 Volume 28 Issue 2 Pages 171-176
Although anomalies of vertebral arteries (VAs), such as fenestration or elongation, are not rare, there are few symptomatic reports in which an anomalous VA directly compresses the spinal cord nerve root. Vertebral artery anomalies have been reported to cause a variety of symptoms including neck pain, upper limb pain, and occipital neuralgia. The embryological development of the vertebrobasilar system may explain this anatomical anomaly. Here, we report a case of neuralgia in the upper limb caused by bilateral anomalous VAs with compression of the upper cervical cord. A 55-year-old man complained of a sharp and stabbing pain in the left suboccipital region and left upper limb. Neurological findings on admission showed no definite abnormality. MRI showed a flow void signal that compressed and distorted the cross section of the spinal cord at the level of C1-2. A vertebral artery angiogram and 3D-CTA showed that the bilateral vertebral arteries had pierced the dura mater under the posterior arch of the atlas and that the left VA was duplicated after emerging from the C2 transverse foramen. Given these findings, we diagnosed the symptoms suffered as arising from the bilateral anomalous VAs. Surgical treatment included a suboccipital craniectomy, a C1 laminectomy, and transposition of the vertebral arteries. The spinal cord was surgically decompressed by retracting the VAs with Gore-Tex tape and anchoring them to the C1 posterior arch. Postoperatively, the pain was relieved markedly and has not recurred for one year. A review of the literature and our case suggest that symptoms are completely relieved when surgical treatment includes transposition of the anomalous vertebral arteries. We emphasize the effectiveness of direct appropriate treatment.
