Aberrant posterior inferior cerebellar artery injury with C1 lateral mass screw placement: A case report and review of the literature

Ahmad N. Nassr, Presley P. Swann, John III Huston, Mohamed M. Abdelfatah, Peter S. Rose, Bradford L. Currier

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background context Complications associated with C1 lateral mass screw placement are relatively infrequent. The most commonly feared complications include neural or vascular injury. Although both vertebral artery and internal carotid artery injuries have been discussed in the literature, there have been no reports of posterior inferior cerebellar artery (PICA) injury from C1 lateral mass screw placement. We report a case of patient who had a cerebellar stroke after C1 lateral mass screw placement, secondary to injury of an aberrant PICA. Purpose To describe the normal anatomy of the PICA, the anatomic variations previously reported in the literature, the sequela and symptoms of a patient with PICA injury, and the relevance to C1 lateral mass screw placement. No previous reports of PICA injury with a cerebellar stroke have been reported with C1 lateral mass screw instrumentation. Study design Case report and literature review. Methods The patient underwent an Occiput-C6 posterior instrumentation for a pathologic fracture, secondary to multiple myeloma. In the postoperative period, the patient was found to have dysarthria, imbalance, and dysdiadochokinesia. Urgent computed tomography confirmed well placed C1 lateral mass screws. Magnetic resonance imaging/Magnetic Resonance Angiography showed an infarct in the PICA distribution with an abnormal variant of the PICA coursing extracranially around C1. Neurologic monitoring did not detect the injury intraoperatively. Results The patient was treated with anticoagulation and he made a reasonable recovery from his stroke. Conclusions We report the first case of an aberrant PICA injured during a C1 lateral mass screw placement, resulting in a cerebellar stroke. Consideration should be given to abnormal PICA variation when placing C1 lateral mass screws.

Original languageEnglish (US)
JournalSpine Journal
Volume14
Issue number9
DOIs
StatePublished - Sep 1 2014

Fingerprint

Arteries
Wounds and Injuries
Stroke
Carotid Artery Injuries
Anatomic Variation
Dysarthria
Spontaneous Fractures
Vertebral Artery
Magnetic Resonance Angiography
Vascular System Injuries
Internal Carotid Artery
Multiple Myeloma
Postoperative Period
Nervous System
Anatomy
Tomography
Magnetic Resonance Imaging

Keywords

  • Aberrant vascular anatomy in the cervical spine
  • C1 lateral mass screw placement
  • Complications of c1 lateral mass screw placement
  • Complications of cervical spine instrumentation
  • Posterior inferior cerebellar artery (PICA)
  • Posterior inferior cerebellar artery injury
  • Stroke after c1 screw placement
  • Vascular injury

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Aberrant posterior inferior cerebellar artery injury with C1 lateral mass screw placement : A case report and review of the literature. / Nassr, Ahmad N.; Swann, Presley P.; Huston, John III; Abdelfatah, Mohamed M.; Rose, Peter S.; Currier, Bradford L.

In: Spine Journal, Vol. 14, No. 9, 01.09.2014.

Research output: Contribution to journalArticle

Nassr, Ahmad N. ; Swann, Presley P. ; Huston, John III ; Abdelfatah, Mohamed M. ; Rose, Peter S. ; Currier, Bradford L. / Aberrant posterior inferior cerebellar artery injury with C1 lateral mass screw placement : A case report and review of the literature. In: Spine Journal. 2014 ; Vol. 14, No. 9.
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abstract = "Background context Complications associated with C1 lateral mass screw placement are relatively infrequent. The most commonly feared complications include neural or vascular injury. Although both vertebral artery and internal carotid artery injuries have been discussed in the literature, there have been no reports of posterior inferior cerebellar artery (PICA) injury from C1 lateral mass screw placement. We report a case of patient who had a cerebellar stroke after C1 lateral mass screw placement, secondary to injury of an aberrant PICA. Purpose To describe the normal anatomy of the PICA, the anatomic variations previously reported in the literature, the sequela and symptoms of a patient with PICA injury, and the relevance to C1 lateral mass screw placement. No previous reports of PICA injury with a cerebellar stroke have been reported with C1 lateral mass screw instrumentation. Study design Case report and literature review. Methods The patient underwent an Occiput-C6 posterior instrumentation for a pathologic fracture, secondary to multiple myeloma. In the postoperative period, the patient was found to have dysarthria, imbalance, and dysdiadochokinesia. Urgent computed tomography confirmed well placed C1 lateral mass screws. Magnetic resonance imaging/Magnetic Resonance Angiography showed an infarct in the PICA distribution with an abnormal variant of the PICA coursing extracranially around C1. Neurologic monitoring did not detect the injury intraoperatively. Results The patient was treated with anticoagulation and he made a reasonable recovery from his stroke. Conclusions We report the first case of an aberrant PICA injured during a C1 lateral mass screw placement, resulting in a cerebellar stroke. Consideration should be given to abnormal PICA variation when placing C1 lateral mass screws.",
keywords = "Aberrant vascular anatomy in the cervical spine, C1 lateral mass screw placement, Complications of c1 lateral mass screw placement, Complications of cervical spine instrumentation, Posterior inferior cerebellar artery (PICA), Posterior inferior cerebellar artery injury, Stroke after c1 screw placement, Vascular injury",
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T2 - A case report and review of the literature

AU - Nassr, Ahmad N.

AU - Swann, Presley P.

AU - Huston, John III

AU - Abdelfatah, Mohamed M.

AU - Rose, Peter S.

AU - Currier, Bradford L.

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N2 - Background context Complications associated with C1 lateral mass screw placement are relatively infrequent. The most commonly feared complications include neural or vascular injury. Although both vertebral artery and internal carotid artery injuries have been discussed in the literature, there have been no reports of posterior inferior cerebellar artery (PICA) injury from C1 lateral mass screw placement. We report a case of patient who had a cerebellar stroke after C1 lateral mass screw placement, secondary to injury of an aberrant PICA. Purpose To describe the normal anatomy of the PICA, the anatomic variations previously reported in the literature, the sequela and symptoms of a patient with PICA injury, and the relevance to C1 lateral mass screw placement. No previous reports of PICA injury with a cerebellar stroke have been reported with C1 lateral mass screw instrumentation. Study design Case report and literature review. Methods The patient underwent an Occiput-C6 posterior instrumentation for a pathologic fracture, secondary to multiple myeloma. In the postoperative period, the patient was found to have dysarthria, imbalance, and dysdiadochokinesia. Urgent computed tomography confirmed well placed C1 lateral mass screws. Magnetic resonance imaging/Magnetic Resonance Angiography showed an infarct in the PICA distribution with an abnormal variant of the PICA coursing extracranially around C1. Neurologic monitoring did not detect the injury intraoperatively. Results The patient was treated with anticoagulation and he made a reasonable recovery from his stroke. Conclusions We report the first case of an aberrant PICA injured during a C1 lateral mass screw placement, resulting in a cerebellar stroke. Consideration should be given to abnormal PICA variation when placing C1 lateral mass screws.

AB - Background context Complications associated with C1 lateral mass screw placement are relatively infrequent. The most commonly feared complications include neural or vascular injury. Although both vertebral artery and internal carotid artery injuries have been discussed in the literature, there have been no reports of posterior inferior cerebellar artery (PICA) injury from C1 lateral mass screw placement. We report a case of patient who had a cerebellar stroke after C1 lateral mass screw placement, secondary to injury of an aberrant PICA. Purpose To describe the normal anatomy of the PICA, the anatomic variations previously reported in the literature, the sequela and symptoms of a patient with PICA injury, and the relevance to C1 lateral mass screw placement. No previous reports of PICA injury with a cerebellar stroke have been reported with C1 lateral mass screw instrumentation. Study design Case report and literature review. Methods The patient underwent an Occiput-C6 posterior instrumentation for a pathologic fracture, secondary to multiple myeloma. In the postoperative period, the patient was found to have dysarthria, imbalance, and dysdiadochokinesia. Urgent computed tomography confirmed well placed C1 lateral mass screws. Magnetic resonance imaging/Magnetic Resonance Angiography showed an infarct in the PICA distribution with an abnormal variant of the PICA coursing extracranially around C1. Neurologic monitoring did not detect the injury intraoperatively. Results The patient was treated with anticoagulation and he made a reasonable recovery from his stroke. Conclusions We report the first case of an aberrant PICA injured during a C1 lateral mass screw placement, resulting in a cerebellar stroke. Consideration should be given to abnormal PICA variation when placing C1 lateral mass screws.

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KW - Complications of cervical spine instrumentation

KW - Posterior inferior cerebellar artery (PICA)

KW - Posterior inferior cerebellar artery injury

KW - Stroke after c1 screw placement

KW - Vascular injury

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