Name: 10.3171/2024.1.FOCVID23234
Uploaded: 2024-03-08T00:00:00.0000000
Duration: T00H03M42S
Description: 10.3171/2024.1.FOCVID23234

Name: 10.3171/2024.1.FOCVID23234

Description: 10.3171/2024.1.FOCVID23234

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Duration: T00H03M42S

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Upload Date: 2024-03-08T00:00:00.0000000

Transcript: Language: EN.
Segment:0 .
[MUSIC PLAYING]
SPEAKER 1: The patient is a 22-year-old with a history of a left C1 avulsion fracture who presented with dizziness and visual changes. He was found to have multiple infarcts on MRI. And a CTA showed a C1 osteophyte impinging the left vertebral artery, causing a pseudoaneurysm. Despite anticoagulation, he had a progression of his strokes and remained symptomatic. The patient underwent dynamic cerebral angiogram, which showed non–flow- limiting stenosis at the level of C1–2 associated with protruding chronic C1 avulsion fracture of C1.
SPEAKER 2: The patient was placed prone in three-point fixation with a Mayfield head holder with the sheath protected in the event of a vertebral artery hemorrhage. First, the puncture site was confirmed using fluoroscopy and an anterior- posterior and lateral view confirming the entrance at the C1–2 joint. We chose the skin incision based on approximately a 45-degree angle to the lateral aspect of the joint, which was approximately 2 to 3 cm off midline.
SPEAKER 2: This was localized with a spinal needle. We performed a 7- mm cross section with the opening of the fascia and insertion of a dilator and working cannula, always watching for bone contact with the lateral edge of the bone window or the lateral edge of the facet joint. Via small skin incision, serial dilators were advanced and a dilator was advanced onto the lateral atlantoaxial joint.
SPEAKER 2: A tubular retractor was placed and a laminoscope, which was 7.3 mm in diameter, was brought in. Under direct visualization, soft tissue was dissected off the C1–2 joint using bipolar cautery and the micropunch rongeur.
SPEAKER 1: Once the lateral atlantoaxial joint was exposed, we visualized the protruding traumatic C1 osteophyte. Using a 3.5-mm diamond burr, the lateral aspect of the C1 osteophyte was resected. Once the lateral surface of the C1 lateral mass was flush with the lateral surface of C1, we carefully utilized a Kerrison Rongeur to decompress the vertebral artery. Paying close attention to the vertebral artery, the micropunch was used to remove any tissue and remaining fragments encroaching on the vessel.
SPEAKER 1: Good flow of the vertebral artery was confirmed with an intraoperative doppler. A postoperative cerebral angiogram was obtained through his radial access showing the left vertebral artery with a similar appearance of the known cervical dissection. There was interval removal of the bone spur from the inferior aspect of the C1 lateral mass.
SPEAKER 1: The patient was discharged from the hospital the following day without any complication. He returned to clinic 3 months after his procedure, and his CTA showed a stable, resolving pseudoaneurysm with excellent decompression of the osteophyte.

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