PMC9560547_01
(a) Preoperative magnetic resonance imaging showing bilateral vascular loops compressing and distorting the spinal cord. (b) 3DCTA showing that the VAs enter the spinal canal between the atlas and the axis. The C1 posterior arch is deleted with image processing. (c) 3DCTA showing an aberrant course of both VAs. The right PICA (arrow) originates from the intracranial segment of the VA, and the left PICA (arrowhead) originates from the basilar artery as a common trunk with the anterior inferior cerebellar artery. PICA, posterior inferior cerebellar artery; 3DCTA, three-dimensional computed tomographic angiogram; VA, vertebral artery
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The spinal cord was severely compressed and deformed by both VAs (Fig. 1a). Three-dimensional computed tomography angiography revealed an aberrant course of both VAs, which entered the spinal canal between the atlas and the axis (Fig. 1b, c).
Intraoperative photographs. (a) Bilateral VAs compress the spinal cord. The C2 dorsal rootlets (arrowheads) are observed on the surface of the VA. (b) After transposition of the VAs using Teflon slings (arrows), a small space is created between the VAs and the spinal cord. VA, vertebral artery
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Both VAs coursed medially after entry into the spinal canal to indent the posterolateral aspect of the cervical cord (Fig. 2a), with the compression being more severe on the left side. Although the space between the VAs and the spinal cord was minimal, spinal cord decompression was maintained (Fig. 2b).