Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Neuroradiology
Published in: Neuroradiology 6/2008

01-06-2008 | Diagnostic Neuroradiology

Abnormal course of the vertebral artery at the craniovertebral junction in patients with Down syndrome visualized by three-dimensional CT angiography

Authors: Masashi Yamazaki, Akihiko Okawa, Mitsuhiro Hashimoto, Atsuomi Aiba, Yukio Someya, Masao Koda

Published in: Neuroradiology | Issue 6/2008

Login to get access

Abstract

Introduction

We determined the incidence of vertebral artery (VA) anomalies at the craniovertebral junction (CVJ) in patients with Down syndrome, and characterized the VA anomalies.

Methods

The course of the VA in 46 consecutive patients who were due to undergo posterior arthrodesis surgery at the CVJ were evaluated by three-dimensional CT angiography (3DCTA). Included were five patients with Down syndrome who suffered from myelopathy due to atlantoaxial subluxation. All five patients with Down syndrome also had a simultaneous congenital skeletal anomaly, either os odontoideum or ossiculum terminale.

Results

Of the five patients with Down syndrome, three had VA anomalies at the CVJ, two had fenestration and one had a persistent first intersegmental artery. Of the other 41 patients without Down syndrome, five had VA anomalies at the CVJ. The incidence of VA anomalies at the CVJ was much higher in patients with Down syndrome than in those without Down syndrome.

Conclusion

In planning surgery in patients with Down syndrome with symptomatic atlantoaxial subluxation and a congenital skeletal anomaly at the CVJ, we should consider the possible presence of VA anomalies. Preoperative 3DCTA allows us to precisely identify an anomalous VA and evaluate the possible risk of intraoperative VA injury in advance.
Literature
1.
Tredwell SJ, Newman DE, Lockitch G (1990) Instability of the upper cervical spine in Down syndrome. J Pediatr Orthop 10:602–606PubMed
2.
Pueschel SM, Scola FH (1987) Atlantoaxial instability in individuals with Down syndrome: epidemiologic, radiographic, and clinical studies. Pediatrics 80:555–560PubMed
3.
Semine AA, Ertel AN, Goldberg MJ, Bull MJ (1978) Cervical-spine instability in children with Down syndrome (trisomy 21). J Bone Joint Surg Am 60:649–652PubMed
4.
Kobori M, Takahashi H, Mikawa Y (1986) Atlanto-axial dislocation in Down’s syndrome. Report of two cases requiring surgical correction. Spine 11:195–200PubMedCrossRef
5.
Taggard DA, Menezes AH, Ryken TC (2000) Treatment of Down syndrome-associated craniovertebral junction abnormalities. J Neurosurg 93:205–213PubMed
6.
Segal LS, Drummond DS, Zanotti RM, Ecker ML, Mubarak SJ (1991) Complications of posterior arthrodesis of the cervical spine in patients who have Down syndrome. J Bone Joint Surg Am 73:1547–1554PubMed
7.
Wright NM, Lauryssen C (1998) Vertebral artery injury in C1-2 transarticular screw fixation: results of a survey of the AANS/CNS section on disorders of the spine and peripheral nerves. American Association of Neurological Surgeons/Congress of Neurological Surgeons. J Neurosurg 88:634–640PubMed
8.
Tokuda K, Miyasaka K, Abe H, Abe S, Takei H, Sugimoto S, Tsuru M (1985) Anomalous atlantoaxial portions of vertebral and posterior inferior cerebellar arteries. Neuroradiology 27:410–413PubMedCrossRef
9.
Sato K, Watanabe T, Yoshimoto T, Kameyama M (1994) Magnetic resonance imaging of C2 segmental type of vertebral artery. Surg Neurol 41:45–51PubMedCrossRef
10.
Taneichi H, Suda K, Kajino T, Kaneda K (2005) Traumatically induced vertebral artery occlusion associated with cervical spine injuries: prospective study using magnetic resonance angiography. Spine 30:1955–1962PubMedCrossRef
11.
Yamazaki M, Koda M, Aramomi MA, Hashimoto M, Masaki Y, Okawa A (2005) Anomalous vertebral artery at the extraosseous and intraosseous regions of the craniovertebral junction: analysis by three-dimensional computed tomography angiography. Spine 30:2452–2457PubMedCrossRef
12.
Yamazaki M, Koda M, Yoneda M, Aiba A, Moriya H (2004) Anomalous vertebral artery at the craniovertebral junction in a patient with Down syndrome. Case report. J Neurosurg Spine 1:338–341PubMedCrossRef
13.
Yamazaki M, Okawa A, Aramomi MA, Hashimoto M, Masaki Y, Koda M (2004) Fenestration of vertebral artery at the craniovertebral junction in Down syndrome: a case report. Spine 29:E551–E554PubMedCrossRef
14.
Knox GE, ten Bensel RW (1972) Gastrointestinal malformations in Down’s Syndrome. Minn Med 55:542–544PubMed
15.
Shikata J, Yamamuro T, Mikawa Y, Iida H, Kobori M (1987) Surgical treatment of symptomatic atlantoaxial subluxation in Down’s syndrome. Clin Orthop Relat Res 220:111–118PubMed
16.
Nader-Sepahi A, Casey AT, Hayward R, Crockard HA, Thompson D (2005) Symptomatic atlantoaxial instability in Down syndrome. J Neurosurg 103:231–237PubMed
17.
Braakhekke JP, Gabreels FJ, Renier WO, van Rens TJ, Thijssen HO, Begeer JH (1985) Cranio-vertebral pathology in Down syndrome. Clin Neurol Neurosurg 87:173–179PubMedCrossRef
18.
Currarino G (2002) Segmentation defect in the midodontoid process and its possible relationship to the congenital type of os odontoideum. Pediatr Radiol 32:34–40PubMedCrossRef
19.
Lo RN, Leung MP, Lau KC, Yeung CY (1986) Abnormal radial artery in Down’s syndrome. Arch Dis Child 61:885–890PubMed
20.
Tandon R, Edwards JE (1973) Cardiac malformations associated with Down’s syndrome. Circulation 47:1349–1355PubMed
21.
Rathore MH, Sreenivasan VV (1989) Vertebral and right subclavian artery abnormalities in the Down syndrome. Am J Cardiol 63:1528–1529PubMedCrossRef
Metadata
Title
Abnormal course of the vertebral artery at the craniovertebral junction in patients with Down syndrome visualized by three-dimensional CT angiography
Authors
Masashi Yamazaki
Akihiko Okawa
Mitsuhiro Hashimoto
Atsuomi Aiba
Yukio Someya
Masao Koda
Publication date
01-06-2008
Publisher
Springer-Verlag
Published in
Neuroradiology / Issue 6/2008
Print ISSN: 0028-3940
Electronic ISSN: 1432-1920
DOI
https://doi.org/10.1007/s00234-008-0368-8

Other articles of this Issue 6/2008

Neuroradiology 6/2008 Go to the issue

Diagnostic Neuroradiology

The venous manifestations of pulse wave encephalopathy: windkessel dysfunction in normal aging and senile dementia

Diagnostic Neuroradiology

In vivo visualization and analysis of 3-D hemodynamics in cerebral aneurysms with flow-sensitized 4-D MR imaging at 3 T

Book Review

Bernhard Schaller (ed.): Imaging of carotid artery stenosis

Functional Neuroradiology

Differentiation of infective from neoplastic brain lesions by dynamic contrast-enhanced MRI

Invited Editorial

ARUBA – beating natural history in unruptured brain AVMs by intervention

Invited Editorial

Arguments against the proposed randomised trial (ARUBA)