PMC7294169_01
Preoperative magnetic resonance imaging and three- dimensional computed tomography (3D-CT) angiogram (Arrow: spinal cord was compressed from behind by vertebral arteries [VAs]. Both sides of VAs were running touched medially). Bilateral VAs compress spinal cord from behind. These VAs are close to each other. a: sagittal T2-weighted image. b: axial T2-weighted image. c: magnetic resonance angiography. d: 3D-CT angiogram of preoperative. Bilateral persistent first intersegmental arteries were running medially and were entering at C1 and C2 level. The left side of VAs formed fenestration.
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F1
The MR showed compression of the medulla/spinal cord posteriorly due to bilateral tortuous/anomalous VAs running medially at the C1 level [Figure 1a-c]. The three-dimensional CT (3D-CT) angiogram additionally confirmed bilateral PFIA running medially and entering the spinal canal between the C1 and C2 levels, and on the left side, a "fenestration of the VA [Figure 1d]."
Intraoperative photographs. a: bilateral vertebral arteries (VAs) compressed the spinal cord at the C1 level. b: vinyl prosthesis (arrow) inserted between dura and the right side VA. This VA was fixed to prosthesis with Aron Alpha. c: left-side VA was fixed in the same way. d: finally, large vinyl prosthesis anchored between both of VAs due not to reposition VAs.
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F2
In addition, a large vinyl prosthesis was placed between both VAs /PTIFAs to prevent them from contacting and compressing the cord [Figure 2].
Postoperative magnetic resonance imaging and three- dimensional computed tomography (3D-CT) angiogram. Compression of the spinal cord was released by vertebral artery movement (arrow). a: sagittal T2-weighted image. b: axial T2-weighted image. c: magnetic resonance angiography. d: 3D-CT angiogram.
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F3
The postoperative MR and 3D-CT angiograms confirmed that both VAs were no longer compressing the spinal cord [Figure 3].