PMC5981184_01
Fusion images by MRI and three-dimensional computed tomography (3D-CT) angiography. (a) Preoperation, (b) postoperation. (a) shows the anomalous course of the left VA, which entered the spinal canal between the axis and atlas (arrowhead). There was no fenestration of the VA and no laterality of the diameter of the VA. The intradural course of the left VA formed a vascular loop and compressed the spinal cord at the C1 level (arrow). (b) shows that the left VA was separated from the surface of the cord accompanied by C1 laminectomy (arrow)
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F1
Tokyo, Japan] using MRI and three-dimensional computed tomography [3D-CT] angiography) [Figure 1a]. The VA that entered the spinal canal between the axis and atlas and compressed the spinal cord at the C1 level [Figure 2a and b]. The intradural course of the left VA formed the vascular loop and compressed the cord at the C1 level. T2-weighted MRI showed that the left VA was separated from the surface of the cord [Figure 2c and d]. The postoperative fusion MRI and 3D-CT angiography [Figure 1b] also revealed that the left VA was separated from the surface of the cord following the C1 laminectomy.
Pre- and postoperative MRI findings. (a) Motion-sensitized driven-equilibrium-turbo spin echo (MSDE-TSE), (b) T2-WI: preoperative magnetic resonance imaging (MRI). (c) MSDE-TSE, (d) T2-weighted image (T2-WI): postoperative MRI. (a) shows that the cervical cord at the C1 level is compressed by the left vertebral artery (VA). (b) shows an abnormal flow void indicating that the left VA is compressing the spinal cord at the C1 level without a signal change in the spinal cord. (c) and (d) show that the left VA was separated from the surface of the cord. The compression of the cord was relieved after the operation
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PMC5981184_01_SNI-9-101-g002.jpg
F2
Tokyo, Japan] using MRI and three-dimensional computed tomography [3D-CT] angiography) [Figure 1a]. The VA that entered the spinal canal between the axis and atlas and compressed the spinal cord at the C1 level [Figure 2a and b]. The intradural course of the left VA formed the vascular loop and compressed the cord at the C1 level. T2-weighted MRI showed that the left VA was separated from the surface of the cord [Figure 2c and d]. The postoperative fusion MRI and 3D-CT angiography [Figure 1b] also revealed that the left VA was separated from the surface of the cord following the C1 laminectomy.
Intraoperative photographs. (a) The vascular loop of the left VA compressed the cervical cord at the C1 level and C2 dorsal nerve roots (arrow). (b) Impression by the left VA on the cord and stretched C2 nerve roots was observed (arrow). (c) The left VA was mobilized laterally and anchored to the dura mater by PTEF tape to relieve the cord compression
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F3
The left VA was mobilized laterally and anchored to the dura mater by PTEF tape (2 mm; BARD) [Figure 3].