Maldevelopmental pathology of the vertebral artery in infancy and childhood

The vertebral artery (VA), whose embryogenesis differs from that of any other vessel, is characterized by a great variety of malformations and anomalies. Some of the malformations are truly pathological (that is symptomatic); the anomalies are either found by chance postmorten or by angiography. All of these should be kept in mind by the surgeon approaching the deep cervical and craniospinal regions as well as by the interventional radiologist. In the context of a literature review we discuss the width and length anomalies of the VA, tortuosity and kinking, course anomalies, duplication and fenestration, persistence of primitive arteries, and anomalies of collateral branches. Other pathologies of the cervical VA associated exclusively with genetic diseases, such as spontaneous aneurysms and arteriovenous fistulae in neurofibromatosis type 1 are also considered.