Nancy Rollins1, Bruno Braga2, Amy Hogge2, Stefanie Beavers2, Michael Dowling2. 1. From the Divisions of Pediatrics in the Departments of Radiology (N.R.), Neurosurgery (N.R., B.B.), and Neurology (M.D.), Children's Health System of Texas, University of Texas Southwestern Medical Center, Dallas; and Anesthesia for Children (A.H.) and Center for Cerebrovascular Disease in Children (S.B.), Children's Health System of Texas, Dallas. nancy.rollins@childrens.com. 2. From the Divisions of Pediatrics in the Departments of Radiology (N.R.), Neurosurgery (N.R., B.B.), and Neurology (M.D.), Children's Health System of Texas, University of Texas Southwestern Medical Center, Dallas; and Anesthesia for Children (A.H.) and Center for Cerebrovascular Disease in Children (S.B.), Children's Health System of Texas, Dallas.
Abstract
BACKGROUND AND PURPOSE: The pathogenesis of spontaneous pediatric vertebral artery dissections (VAD) is poorly understood but most often involves the V3 segment where C1 rotates on C2. We studied children with VAD with provocative digital catheter angiography and found an association between VAD and rotational compression. METHODS: Seven boys (12 months to 9 years; median 4 years) presented over 38 consecutive months with V3 VAD and underwent digital catheter angiography with provocative passive bilateral neck rotation. RESULTS: VAD were bilateral in 2 patients and unilateral in 5. Provocative digital catheter angiography showed dynamic V3 compression in 6 of 9 dissections, most pronounced or seen only with head rotation to the contralateral side. Two patients had VAD without dynamic compression; both returned 4 months later with a new dissection in a previously normal VA and worsening VAD in 1 patient each. Dynamic compression was also seen in 2 nondissected VA. Surgical management was C1/2 posterior fusion in 5 of 7 patients; 1 underwent unilateral C2 decompression with recurrent VAD and was subsequently fused. CONCLUSIONS: The association of dynamic VA compression and VAD at the same level suggests that the compression may contribute to the VAD. However, as dynamic compression was observed in nondissected VA and some VAD were not associated with dynamic compression, VAD may be multifactorial.
BACKGROUND AND PURPOSE: The pathogenesis of spontaneous pediatric vertebral artery dissections (VAD) is poorly understood but most often involves the V3 segment where C1 rotates on C2. We studied children with VAD with provocative digital catheter angiography and found an association between VAD and rotational compression. METHODS: Seven boys (12 months to 9 years; median 4 years) presented over 38 consecutive months with V3 VAD and underwent digital catheter angiography with provocative passive bilateral neck rotation. RESULTS: VAD were bilateral in 2 patients and unilateral in 5. Provocative digital catheter angiography showed dynamic V3 compression in 6 of 9 dissections, most pronounced or seen only with head rotation to the contralateral side. Two patients had VAD without dynamic compression; both returned 4 months later with a new dissection in a previously normal VA and worsening VAD in 1 patient each. Dynamic compression was also seen in 2 nondissected VA. Surgical management was C1/2 posterior fusion in 5 of 7 patients; 1 underwent unilateral C2 decompression with recurrent VAD and was subsequently fused. CONCLUSIONS: The association of dynamic VA compression and VAD at the same level suggests that the compression may contribute to the VAD. However, as dynamic compression was observed in nondissected VA and some VAD were not associated with dynamic compression, VAD may be multifactorial.
Authors: Peter B Sporns; Heather J Fullerton; Sarah Lee; Helen Kim; Warren D Lo; Mark T Mackay; Moritz Wildgruber Journal: Nat Rev Dis Primers Date: 2022-02-24 Impact factor: 52.329
Authors: Z Ritchey; T J Bernard; L Z Fenton; J A Maloney; D M Mirsky; I Neuberger; I Sriram; J Seinfeld; N V Stence Journal: AJNR Am J Neuroradiol Date: 2022-05-12 Impact factor: 4.966
Authors: Christine K Fox; Heather J Fullerton; Steven W Hetts; Van V Halbach; Kurtis I Auguste; Michael T Lawton; Nalin Gupta Journal: Neurology Date: 2020-07-20 Impact factor: 9.910
Authors: Mubeen F Rafay; Kevin A Shapiro; Ann-Marie Surmava; Gabrielle A deVeber; Adam Kirton; Heather J Fullerton; Catherine Amlie-Lefond; Bernhard Weschke; Nomazulu Dlamini; Jessica L Carpenter; Mark T Mackay; Michael Rivkin; Alexandra Linds; Timothy J Bernard Journal: Neurology Date: 2020-05-26 Impact factor: 9.910
Authors: M Travis Caton; Kazim Narsinh; Amanda Baker; Adib A Abla; Jarod L Roland; Van V Halbach; Christine K Fox; Heather J Fullerton; Steven W Hetts Journal: J Neurosurg Case Lessons Date: 2021-01-18