VA Injury  

Posted bythespinebookadminPosted inComplications

RF 

  • Anteriorly C7 
  • Laterally C3-6 
  • Posterior C1-2 
  • Aberrant pathology 

Anatomy 

  • V1 
    • Extraosseous 
    • Subclavian, anterior to C7 TP, entry to C6 transverrse foramen 
  • V2 
    • Within transverse foamina of C6-C1 
    • Risk during lateral mass 
  • V3 
    • Superior to arch of atlas to foramen magnum 
    • Vulnerable during lateral exposure and C1 laminectomy (don’t go 1cm past midline at arch 
  • V4 
    • Intradural extension from foramen magnum to unite with contralateral side – forms basilar artery 

Consequences of Dominant Injury 

  • Vertebrobasilar Insufficiency 
    • Dizziness 
    • Vertigo 
    • Nausea 
    • Diplopia, blindness 
    • Ataxia (cerebellar) 
    • Bilateral weakness 
    • Oropharyngeal dysfunction 
  • Wallenberg 
  • Cerebellar infarct 
  • Cranial nerve palsy 
  • Mortality 12% 

Management 

  • Inform anesthesia anticipate 3L blood loss 
  • Plug small screw 10mm to plug hole 
  • Stabilize spine with unilateral construct 
  • Page VSx and IR 
  • Local control 
    • Direct pressure tamponade 
    • No bone wax/ hemostatic (embolic event) 
    • Suckers up 
  • 3 options 
    • Unstable – immediate coiling (put screw in) 
      • IR 
        • Check for collateral flow 
        • Dominant artery- they will reconstitute 
        • Nondominant – they will ligaet 
    • Stable non dominant – explore and ligate after clamp test for retograde flow 
    • Stable dominant – explore, vascula Sx repair 
  • Post op ICU anticoag 
    • ASA 
  • 5-0 prolene to repair