Strategies to avoid internal carotid artery injury in “sandwich” atlantoaxial dislocation patients during surgery
Purpose To elucidate the anatomic relationship between the internal carotid artery (ICA) and the bony structures of the craniovertebral junction among “sandwich” atlantoaxial dislocation (AAD) patients, and to analyze the risks of injury during surgical procedures. Methods The distance from the medi...
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| Veröffentlicht in: | Acta neurochirurgica 2023-05, Vol.165 (5), p.1155-1160 |
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| creator | Tian, Yinglun Xu, Nanfang Yan, Ming Chen, Jinguo Hung, Kan-Lin Hou, Xiangyu Wang, Shenglin Li, Weishi |
| description | Purpose
To elucidate the anatomic relationship between the internal carotid artery (ICA) and the bony structures of the craniovertebral junction among “sandwich” atlantoaxial dislocation (AAD) patients, and to analyze the risks of injury during surgical procedures.
Methods
The distance from the medial wall of ICA to the midsagittal plane (D1), the shortest distance between the ICA wall and the anterior cortex of the lateral mass of atlas (LMA) (D2) on the most caudal and cranial levels of LMA and the angle (A) between the sagittal plane passing through the screw entry point of C1 lateral mass(C1LM) screw and the medial tangent line of the vessel passing through the entry point were measured. Besides, the location of ICA in front of the atlantoaxial vertebra was divided into 4 categories (Z1–Z4).
Results
There was a statistically difference between the male and female patients regarding D1, and the difference between D2 at level a and level b as well as angle A between the left and right sides were statistically different (
p
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| doi_str_mv | 10.1007/s00701-022-05449-7 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2755801158</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2806675489</sourcerecordid><originalsourceid>FETCH-LOGICAL-c375t-f70a03cc75da42f0e58c196a980e057761de456a5a0385b44ca8390deeb2e8b63</originalsourceid><addsrcrecordid>eNp9kU1uFDEQha0IlP8LsECW2LBpKHfbbfcSRSFBipQFsLZq3DWDRz3twXaTZJeDJJfLSeLJBIJYsPGzS1-9suox9kbABwGgP6ZygKigritQUnaV3mH70Mny7CS8-uu-xw5SWgKIWstml-01rWqkMO0-m77miJkWnhLPgeOv4Hvux0xxxIE7jCGXAsZSuCn15fQk_OH2LuHYX3n34-H2nmMecMwBr31p6n0agsPsw8jXRWjMifdT9OOCpykuitMRez3HIdHxsx6y759Pv52cVxeXZ19OPl1UrtEqV3MNCI1zWvUo6zmQMk50LXYGCJTWrehJqhZVoYyaSenQNB30RLOazKxtDtn7re86hp8TpWxXPjkaym8pTMnWWikDQihT0Hf_oMswbZZQKANtq5U0XaHqLeViSCnS3K6jX2G8sQLsJhS7DcWWUOxTKFaXprfP1tNsRf2flt8pFKDZAmm92RLFl9n_sX0ErHqbPg</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2806675489</pqid></control><display><type>article</type><title>Strategies to avoid internal carotid artery injury in “sandwich” atlantoaxial dislocation patients during surgery</title><source>MEDLINE</source><source>Springer Nature - Complete Springer Journals</source><creator>Tian, Yinglun ; Xu, Nanfang ; Yan, Ming ; Chen, Jinguo ; Hung, Kan-Lin ; Hou, Xiangyu ; Wang, Shenglin ; Li, Weishi</creator><creatorcontrib>Tian, Yinglun ; Xu, Nanfang ; Yan, Ming ; Chen, Jinguo ; Hung, Kan-Lin ; Hou, Xiangyu ; Wang, Shenglin ; Li, Weishi</creatorcontrib><description>Purpose
To elucidate the anatomic relationship between the internal carotid artery (ICA) and the bony structures of the craniovertebral junction among “sandwich” atlantoaxial dislocation (AAD) patients, and to analyze the risks of injury during surgical procedures.
Methods
The distance from the medial wall of ICA to the midsagittal plane (D1), the shortest distance between the ICA wall and the anterior cortex of the lateral mass of atlas (LMA) (D2) on the most caudal and cranial levels of LMA and the angle (A) between the sagittal plane passing through the screw entry point of C1 lateral mass(C1LM) screw and the medial tangent line of the vessel passing through the entry point were measured. Besides, the location of ICA in front of the atlantoaxial vertebra was divided into 4 categories (Z1–Z4).
Results
There was a statistically difference between the male and female patients regarding D1, and the difference between D2 at level a and level b as well as angle A between the left and right sides were statistically different (
p
< 0.05). Ninety-two ICAs (57.5%) were anteriorly located in Z3, 50 (31.3%) were located in Z4, 17 were located in Z2, and only one ICA was located in Z1 in all 80 patients.
Conclusions
In “sandwich” AAD patients, particular attention should be paid to excessively medialized ICA to avoid ICA injury during trans-oral procedures, and the risk of injuring the ICA with more cranially and medially angulated C1LM screw placement was relatively less during posterior fixation procedures. A novel classification of ICA location was used to describe the relationship between ICA and LMA.</description><identifier>ISSN: 0942-0940</identifier><identifier>ISSN: 0001-6268</identifier><identifier>EISSN: 0942-0940</identifier><identifier>DOI: 10.1007/s00701-022-05449-7</identifier><identifier>PMID: 36534186</identifier><language>eng</language><publisher>Vienna: Springer Vienna</publisher><subject>Atlanto-Axial Joint - diagnostic imaging ; Atlanto-Axial Joint - surgery ; Bone Screws ; Carotid arteries ; Carotid artery ; Carotid Artery Injuries ; Carotid Artery, Internal - diagnostic imaging ; Carotid Artery, Internal - surgery ; Cervical Vertebrae - surgery ; Dislocation ; Female ; Humans ; Interventional Radiology ; Joint Dislocations - diagnostic imaging ; Joint Dislocations - surgery ; Male ; Medicine ; Medicine & Public Health ; Minimally Invasive Surgery ; Neck Injuries ; Neurology ; Neuroradiology ; Neurosurgery ; Original Article - Spine - Other ; Spinal Fusion - methods ; Spine (cervical) ; Spine - Other ; Surgical Orthopedics ; Vertebrae</subject><ispartof>Acta neurochirurgica, 2023-05, Vol.165 (5), p.1155-1160</ispartof><rights>The Author(s), under exclusive licence to Springer-Verlag GmbH Austria, part of Springer Nature 2022. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><rights>2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Austria, part of Springer Nature.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c375t-f70a03cc75da42f0e58c196a980e057761de456a5a0385b44ca8390deeb2e8b63</citedby><cites>FETCH-LOGICAL-c375t-f70a03cc75da42f0e58c196a980e057761de456a5a0385b44ca8390deeb2e8b63</cites><orcidid>0000-0002-5811-4145</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00701-022-05449-7$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00701-022-05449-7$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27903,27904,41467,42536,51298</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36534186$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Tian, Yinglun</creatorcontrib><creatorcontrib>Xu, Nanfang</creatorcontrib><creatorcontrib>Yan, Ming</creatorcontrib><creatorcontrib>Chen, Jinguo</creatorcontrib><creatorcontrib>Hung, Kan-Lin</creatorcontrib><creatorcontrib>Hou, Xiangyu</creatorcontrib><creatorcontrib>Wang, Shenglin</creatorcontrib><creatorcontrib>Li, Weishi</creatorcontrib><title>Strategies to avoid internal carotid artery injury in “sandwich” atlantoaxial dislocation patients during surgery</title><title>Acta neurochirurgica</title><addtitle>Acta Neurochir</addtitle><addtitle>Acta Neurochir (Wien)</addtitle><description>Purpose
To elucidate the anatomic relationship between the internal carotid artery (ICA) and the bony structures of the craniovertebral junction among “sandwich” atlantoaxial dislocation (AAD) patients, and to analyze the risks of injury during surgical procedures.
Methods
The distance from the medial wall of ICA to the midsagittal plane (D1), the shortest distance between the ICA wall and the anterior cortex of the lateral mass of atlas (LMA) (D2) on the most caudal and cranial levels of LMA and the angle (A) between the sagittal plane passing through the screw entry point of C1 lateral mass(C1LM) screw and the medial tangent line of the vessel passing through the entry point were measured. Besides, the location of ICA in front of the atlantoaxial vertebra was divided into 4 categories (Z1–Z4).
Results
There was a statistically difference between the male and female patients regarding D1, and the difference between D2 at level a and level b as well as angle A between the left and right sides were statistically different (
p
< 0.05). Ninety-two ICAs (57.5%) were anteriorly located in Z3, 50 (31.3%) were located in Z4, 17 were located in Z2, and only one ICA was located in Z1 in all 80 patients.
Conclusions
In “sandwich” AAD patients, particular attention should be paid to excessively medialized ICA to avoid ICA injury during trans-oral procedures, and the risk of injuring the ICA with more cranially and medially angulated C1LM screw placement was relatively less during posterior fixation procedures. A novel classification of ICA location was used to describe the relationship between ICA and LMA.</description><subject>Atlanto-Axial Joint - diagnostic imaging</subject><subject>Atlanto-Axial Joint - surgery</subject><subject>Bone Screws</subject><subject>Carotid arteries</subject><subject>Carotid artery</subject><subject>Carotid Artery Injuries</subject><subject>Carotid Artery, Internal - diagnostic imaging</subject><subject>Carotid Artery, Internal - surgery</subject><subject>Cervical Vertebrae - surgery</subject><subject>Dislocation</subject><subject>Female</subject><subject>Humans</subject><subject>Interventional Radiology</subject><subject>Joint Dislocations - diagnostic imaging</subject><subject>Joint Dislocations - surgery</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Minimally Invasive Surgery</subject><subject>Neck Injuries</subject><subject>Neurology</subject><subject>Neuroradiology</subject><subject>Neurosurgery</subject><subject>Original Article - Spine - Other</subject><subject>Spinal Fusion - methods</subject><subject>Spine (cervical)</subject><subject>Spine - Other</subject><subject>Surgical Orthopedics</subject><subject>Vertebrae</subject><issn>0942-0940</issn><issn>0001-6268</issn><issn>0942-0940</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp9kU1uFDEQha0IlP8LsECW2LBpKHfbbfcSRSFBipQFsLZq3DWDRz3twXaTZJeDJJfLSeLJBIJYsPGzS1-9suox9kbABwGgP6ZygKigritQUnaV3mH70Mny7CS8-uu-xw5SWgKIWstml-01rWqkMO0-m77miJkWnhLPgeOv4Hvux0xxxIE7jCGXAsZSuCn15fQk_OH2LuHYX3n34-H2nmMecMwBr31p6n0agsPsw8jXRWjMifdT9OOCpykuitMRez3HIdHxsx6y759Pv52cVxeXZ19OPl1UrtEqV3MNCI1zWvUo6zmQMk50LXYGCJTWrehJqhZVoYyaSenQNB30RLOazKxtDtn7re86hp8TpWxXPjkaym8pTMnWWikDQihT0Hf_oMswbZZQKANtq5U0XaHqLeViSCnS3K6jX2G8sQLsJhS7DcWWUOxTKFaXprfP1tNsRf2flt8pFKDZAmm92RLFl9n_sX0ErHqbPg</recordid><startdate>20230501</startdate><enddate>20230501</enddate><creator>Tian, Yinglun</creator><creator>Xu, Nanfang</creator><creator>Yan, Ming</creator><creator>Chen, Jinguo</creator><creator>Hung, Kan-Lin</creator><creator>Hou, Xiangyu</creator><creator>Wang, Shenglin</creator><creator>Li, Weishi</creator><general>Springer Vienna</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7TK</scope><scope>7U9</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-5811-4145</orcidid></search><sort><creationdate>20230501</creationdate><title>Strategies to avoid internal carotid artery injury in “sandwich” atlantoaxial dislocation patients during surgery</title><author>Tian, Yinglun ; Xu, Nanfang ; Yan, Ming ; Chen, Jinguo ; Hung, Kan-Lin ; Hou, Xiangyu ; Wang, Shenglin ; Li, Weishi</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c375t-f70a03cc75da42f0e58c196a980e057761de456a5a0385b44ca8390deeb2e8b63</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Atlanto-Axial Joint - diagnostic imaging</topic><topic>Atlanto-Axial Joint - surgery</topic><topic>Bone Screws</topic><topic>Carotid arteries</topic><topic>Carotid artery</topic><topic>Carotid Artery Injuries</topic><topic>Carotid Artery, Internal - diagnostic imaging</topic><topic>Carotid Artery, Internal - surgery</topic><topic>Cervical Vertebrae - surgery</topic><topic>Dislocation</topic><topic>Female</topic><topic>Humans</topic><topic>Interventional Radiology</topic><topic>Joint Dislocations - diagnostic imaging</topic><topic>Joint Dislocations - surgery</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Minimally Invasive Surgery</topic><topic>Neck Injuries</topic><topic>Neurology</topic><topic>Neuroradiology</topic><topic>Neurosurgery</topic><topic>Original Article - Spine - Other</topic><topic>Spinal Fusion - methods</topic><topic>Spine (cervical)</topic><topic>Spine - Other</topic><topic>Surgical Orthopedics</topic><topic>Vertebrae</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Tian, Yinglun</creatorcontrib><creatorcontrib>Xu, Nanfang</creatorcontrib><creatorcontrib>Yan, Ming</creatorcontrib><creatorcontrib>Chen, Jinguo</creatorcontrib><creatorcontrib>Hung, Kan-Lin</creatorcontrib><creatorcontrib>Hou, Xiangyu</creatorcontrib><creatorcontrib>Wang, Shenglin</creatorcontrib><creatorcontrib>Li, Weishi</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Neurosciences Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Acta neurochirurgica</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Tian, Yinglun</au><au>Xu, Nanfang</au><au>Yan, Ming</au><au>Chen, Jinguo</au><au>Hung, Kan-Lin</au><au>Hou, Xiangyu</au><au>Wang, Shenglin</au><au>Li, Weishi</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Strategies to avoid internal carotid artery injury in “sandwich” atlantoaxial dislocation patients during surgery</atitle><jtitle>Acta neurochirurgica</jtitle><stitle>Acta Neurochir</stitle><addtitle>Acta Neurochir (Wien)</addtitle><date>2023-05-01</date><risdate>2023</risdate><volume>165</volume><issue>5</issue><spage>1155</spage><epage>1160</epage><pages>1155-1160</pages><issn>0942-0940</issn><issn>0001-6268</issn><eissn>0942-0940</eissn><abstract>Purpose
To elucidate the anatomic relationship between the internal carotid artery (ICA) and the bony structures of the craniovertebral junction among “sandwich” atlantoaxial dislocation (AAD) patients, and to analyze the risks of injury during surgical procedures.
Methods
The distance from the medial wall of ICA to the midsagittal plane (D1), the shortest distance between the ICA wall and the anterior cortex of the lateral mass of atlas (LMA) (D2) on the most caudal and cranial levels of LMA and the angle (A) between the sagittal plane passing through the screw entry point of C1 lateral mass(C1LM) screw and the medial tangent line of the vessel passing through the entry point were measured. Besides, the location of ICA in front of the atlantoaxial vertebra was divided into 4 categories (Z1–Z4).
Results
There was a statistically difference between the male and female patients regarding D1, and the difference between D2 at level a and level b as well as angle A between the left and right sides were statistically different (
p
< 0.05). Ninety-two ICAs (57.5%) were anteriorly located in Z3, 50 (31.3%) were located in Z4, 17 were located in Z2, and only one ICA was located in Z1 in all 80 patients.
Conclusions
In “sandwich” AAD patients, particular attention should be paid to excessively medialized ICA to avoid ICA injury during trans-oral procedures, and the risk of injuring the ICA with more cranially and medially angulated C1LM screw placement was relatively less during posterior fixation procedures. A novel classification of ICA location was used to describe the relationship between ICA and LMA.</abstract><cop>Vienna</cop><pub>Springer Vienna</pub><pmid>36534186</pmid><doi>10.1007/s00701-022-05449-7</doi><tpages>6</tpages><orcidid>https://orcid.org/0000-0002-5811-4145</orcidid></addata></record> |
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| source | MEDLINE; Springer Nature - Complete Springer Journals |
| subjects | Atlanto-Axial Joint - diagnostic imaging Atlanto-Axial Joint - surgery Bone Screws Carotid arteries Carotid artery Carotid Artery Injuries Carotid Artery, Internal - diagnostic imaging Carotid Artery, Internal - surgery Cervical Vertebrae - surgery Dislocation Female Humans Interventional Radiology Joint Dislocations - diagnostic imaging Joint Dislocations - surgery Male Medicine Medicine & Public Health Minimally Invasive Surgery Neck Injuries Neurology Neuroradiology Neurosurgery Original Article - Spine - Other Spinal Fusion - methods Spine (cervical) Spine - Other Surgical Orthopedics Vertebrae |
| title | Strategies to avoid internal carotid artery injury in “sandwich” atlantoaxial dislocation patients during surgery |
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