Bruno P Braga1,2, Rafael Sillero3,4, Rosalina M Pereira5, Kamran Urgun6, Dale M Swift3,4, Nancy K Rollins4,7, Amy J Hogge4,8, Michael M Dowling4,5,9. 1. Department of Neurological Surgery, UT Southwestern Medical Center, Dallas, TX, USA. bruno.braga@utsouthwestern.edu. 2. Center for Cerebrovascular Disease in Children, Children's Health, Dallas, TX, USA. bruno.braga@utsouthwestern.edu. 3. Department of Neurological Surgery, UT Southwestern Medical Center, Dallas, TX, USA. 4. Center for Cerebrovascular Disease in Children, Children's Health, Dallas, TX, USA. 5. Department of Neurology and Neurotherapeutics, UT Southwestern Medical Center, Dallas, TX, USA. 6. Department of Neurological Surgery, University of California Irvine, Orange, CA, USA. 7. Department of Radiology, UT Southwestern Medical Center, Dallas, TX, USA. 8. Anesthesia for Children, Dallas, TX, USA. 9. Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX, USA.
Abstract
PURPOSE: Our goals are (1) to report a consecutive prospective series of children who had posterior circulation stroke caused by vertebral artery dissection at the V3 segment; (2) to describe a configuration of the vertebral artery that may predispose to rotational compression; and (3) to recommend a new protocol for evaluation and treatment of vertebral artery dissection at V3. METHODS: All children diagnosed with vertebral artery dissection at the V3 segment from September 2014 to July 2020 at our institution were included in the study. Demographic, clinical, surgical, and radiological data were collected. RESULTS: Sixteen children were found to have dissection at a specific segment of the vertebral artery. Fourteen patients were male. Eleven were found to have compression on rotation during a provocative angiogram. All eleven underwent C1C2 posterior fusion as part of their treatment. Their mean age was 6.44 years (range 18 months-15 years). Mean blood loss was 57.7 mL. One minor complication occurred: a superficial wound infection treated with oral antibiotics only. There were no vascular or neurologic injuries. There have been no recurrent ischemic events after diagnosis and/or treatment. Mean follow-up was 33.3 months (range 2-59 months). We designed a new protocol to manage V3 dissections in children. CONCLUSION: Posterior C1C2 fusion is a safe and effective option for treatment of dynamic compression in vertebral artery dissection in children. Institution of and compliance with a strict diagnostic and treatment protocol for V3 segment dissections seem to prevent recurrent stroke.
PURPOSE: Our goals are (1) to report a consecutive prospective series of children who had posterior circulation stroke caused by vertebral artery dissection at the V3 segment; (2) to describe a configuration of the vertebral artery that may predispose to rotational compression; and (3) to recommend a new protocol for evaluation and treatment of vertebral artery dissection at V3. METHODS: All children diagnosed with vertebral artery dissection at the V3 segment from September 2014 to July 2020 at our institution were included in the study. Demographic, clinical, surgical, and radiological data were collected. RESULTS: Sixteen children were found to have dissection at a specific segment of the vertebral artery. Fourteen patients were male. Eleven were found to have compression on rotation during a provocative angiogram. All eleven underwent C1C2 posterior fusion as part of their treatment. Their mean age was 6.44 years (range 18 months-15 years). Mean blood loss was 57.7 mL. One minor complication occurred: a superficial wound infection treated with oral antibiotics only. There were no vascular or neurologic injuries. There have been no recurrent ischemic events after diagnosis and/or treatment. Mean follow-up was 33.3 months (range 2-59 months). We designed a new protocol to manage V3 dissections in children. CONCLUSION: Posterior C1C2 fusion is a safe and effective option for treatment of dynamic compression in vertebral artery dissection in children. Institution of and compliance with a strict diagnostic and treatment protocol for V3 segment dissections seem to prevent recurrent stroke.
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