title: Endovascular embolization of iatrogenic vertebral artery injury during anterior cervical spine surgery: report of two cases and review of the literature.
abstract: METHODS
  Case description.
  
  
  OBJECTIVE
  To report 2 cases of vertebral artery injury (VAI) during anterior cervical decompression surgery and review the pertinent medical literature.
  
  
  BACKGROUND
  The incidence of VAI during an anterior surgical approach to the cervical spine is rare but potentially lethal. The spine surgeon should be aware of the detailed surgical anatomy and be prepared to manage an inadvertent injury to the vertebral artery.
  
  
  METHODS
  In the first case presented, infection was the cause of VAI. During aggressive irrigation and pus drainage, massive bleeding was encountered. For the second case, the vertebral artery was injured during decompression of cervical spondylosis while drilling the neural foramen. Intraoperative direct packing with hemostatic agents provided effective control of hemorrhage.
  
  
  RESULTS
  Ten days after surgery, sudden neck swelling and mental deterioration occurred because of rebleeding from a pseudoaneurysm in the first case. In the second case, a pseudoaneurysm was detected by angiography, obtained 4 days after surgery. Both pseudoaneurysms were successfully occluded by an endovascular technique without any neurologic sequelae.
  
  
  CONCLUSIONS
  In case of bleeding control by hemostatic packing, there remains a risk of delayed hemorrhage from pseudoaneurysm. Postoperative vertebral angiography is helpful to avoid life-threatening complications. Endovascular treatment can be a good alternative in the treatment of VAI.
authors.affiliation: Department of Neurosurgery, Chonnam National University Hospital, Gwangju, Korea.
authors.forename: Jeong-Wook
authors.initials: JW
authors.lastname: Choi
authors.forename: Jung-Kil
authors.initials: JK
authors.lastname: Lee
authors.forename: Kyung-Sub
authors.initials: KS
authors.lastname: Moon
authors.forename: Yeon-Seong
authors.initials: YS
authors.lastname: Kim
authors.forename: Hyoung-Jun
authors.initials: HJ
authors.lastname: Kwak
authors.forename: Sung-Pil
authors.initials: SP
authors.lastname: Joo
authors.forename: Jae-Hyoo
authors.initials: JH
authors.lastname: Kim
authors.forename: Soo-Han
authors.initials: SH
authors.lastname: Kim
mesh_terms: D017541:Aneurysm, False / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D020878:Device Removal / Q000009:adverse effects; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease; D016268:Internal Fixators / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000009:adverse effects*; D011859:Radiography; D013123:Spinal Fusion / Q000009:adverse effects; D013530:Surgical Wound Infection / Q000150:complications; D014711:Vertebral Artery / Q000293:injuries*; D014950:Wounds, Penetrating / Q000150:complications* / Q000209:etiology