PMC6763667_01
Computed tomography angiography examination. (a and b) Sagittal multiplanar reconstruction showing the left internal carotid artery (ICA) dissection with severe vessel stenosis (arrowheads). The close proximity between C1 transverse process and the posterior aspect of the dissected vessel is shown (red arrows). (c) Oblique volume rendering technique reconstruction technique depicts an unusual ICA compression by styloid process anteriorly (white arrow) and C1 transverse process posteriorly (red arrow).
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F1
Three days later, a CTA showed a bilateral ICA dissection with bilateral elongated SPs (35 mm) and a close proximity of ICA with both SPs anteriorly and C1 transverse process posteriorly [Figure 1].
Postoperative computed tomography angiography examination. (a and b) Sagittal multiplanar reconstruction demonstrating the surgically generated distance (red arrows) between the reshaped C1 transverse process (white arrows) and internal carotid artery (ICA) (arrowheads). (c) Volume rendering technique reconstruction image showing the new anatomical relationship between ICA and C1 transverse process (red arrows).
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F2
To decompress the left ICA and at the same time, preserve the main muscular and ligamentous connections of the styloid chain, a portion of the left C1 transverse process was removed using a piezosurgical device [Figure 2].