1
|
Ortega-Balderas JA, Sada-Treviño MA, Barrera-Flores FJ, Zárate-Garza PP, Lugo-Guillén RA, Gómez-Sánchez A, Pinales-Razo R, Elizondo-Riojas G, Guzmán-López S, Elizondo-Omaña RE. Avoiding iatrogenic injuries to the vertebral artery: A morphometric study of the vertebral artery-free dissection area. Clin Neurol Neurosurg 2020; 196:106001. [PMID: 32534385 DOI: 10.1016/j.clineuro.2020.106001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/03/2020] [Accepted: 06/06/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To determine the area of a safety window that excludes the vertebral artery for the safe access of the occipital condyle screws during occipitocervical fixation. METHODS This study included 138 cervical computed tomography angiograms. Six measurements per side were made in each imaging study. These measurements are from the vertebral artery to (A) the mastoid process, (B) the mastoid incisura, (C) the posterior condylar fossa, (D) the occipital condyle in its midline, and (E) the medial border of the condyle. We also measured from the tip of the mastoid process to the lower border of the occipital condyle on its lateral side (F). RESULTS A total of 276 areas from 138 individuals were included, of which 51.4 % were men. The mean age was 54.2 ± 18.63 years. The mean variable measurements (mm) for all the population were 21 ± 4, 16 ± 3, 6 ± 2, 3 ± 2, 2 ± 1 and 35 ± 4 for variables A-F, respectively. We found significant differences between sex when we compared measurements A (p = 0.003), C (p = 0.001), D (p = 0.000) and F (p = 0.000). The incidence rate of dominance for the vertebral artery was 18.8 % and 30.4 % for right and left respectively. CONCLUSION Women had significantly smaller measures than men. This could indicate a higher risk of iatrogenic injury secondary to a smaller vertebral artery-free area. Results may guide surgeons in the pre-surgical planning aiming to reduce the risk of iatrogenic injuries to the vertebral artery.
Collapse
Affiliation(s)
- Jessica A Ortega-Balderas
- Human Anatomy Department, Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey 64460, Nuevo León, Mexico.
| | - Miguel A Sada-Treviño
- Radiology and Imaging Department, Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey 64460, Nuevo León, Mexico.
| | - Francisco J Barrera-Flores
- Human Anatomy Department, Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey 64460, Nuevo León, Mexico.
| | - Pablo P Zárate-Garza
- Human Anatomy Department, Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey 64460, Nuevo León, Mexico.
| | - Roberto A Lugo-Guillén
- Human Anatomy Department, Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey 64460, Nuevo León, Mexico.
| | - Arnulfo Gómez-Sánchez
- Human Anatomy Department, Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey 64460, Nuevo León, Mexico.
| | - Ricardo Pinales-Razo
- Radiology and Imaging Department, Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey 64460, Nuevo León, Mexico.
| | - Guillermo Elizondo-Riojas
- Radiology and Imaging Department, Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey 64460, Nuevo León, Mexico.
| | - Santos Guzmán-López
- Human Anatomy Department, Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey 64460, Nuevo León, Mexico.
| | - Rodrigo E Elizondo-Omaña
- Human Anatomy Department, Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey 64460, Nuevo León, Mexico.
| |
Collapse
|