title: Rotational vertebral artery occlusion-series of 9 cases.
abstract: BACKGROUND
  Rotational vertebral artery syndrome (RVAS) is a rare entity about which previously published studies are mostly limited to individual case reports.
  
  
  OBJECTIVE
  To report our decade-long experience with this syndrome in 9 patients with compression ranging from the occiput to C6.
  
  
  METHODS
  We utilized a posterior approach for lesions rostral to C4 and an anterior approach for lesions at or caudal to C4. Furthermore, we demonstrated the feasibility and efficacy of a minimally invasive posterior cervical approach. Patient profile, operative indications, surgical approach, operative findings, complications, and long-term follow-up were reviewed and discussed.
  
  
  RESULTS
  Average follow-up was 47 months. All procedures provided excellent outcomes by Glasgow Outcome Scale scores. The anterior approach had significantly less blood loss (187.5 mL vs 450 mL, P = .00016) and shorter hospitalization length (2 days vs 4.5 days; P = .0001) compared with the far-lateral approach. There was one complication of cervical instability in the far-lateral approach cohort. As an alternative to the far-lateral surgery, a minimally invasive approach resulted in shorter hospitalization (2 days) and less blood loss (10 mL) while avoiding the complication of cervical instability.
  
  
  CONCLUSIONS
  We demonstrated the safety, efficacy, and durability of 3 surgical approaches for RVAS. Proper examination, preoperative imaging, and surgical planning were necessary for a satisfactory outcome.
authors.affiliation: Department of Neurological Surgery, University of California, Los Angeles, California, USA.
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Lu
authors.forename: Zsolt
authors.initials: Z
authors.lastname: Zador
authors.forename: Praveen V
authors.initials: PV
authors.lastname: Mummaneni
authors.forename: Michael T
authors.initials: MT
authors.lastname: Lawton
mesh_terms: D000368:Aged; D015901:Angiography, Digital Subtraction / Q000379:methods; D002648:Child; D017023:Coronary Angiography / Q000379:methods; D019299:Decompression, Surgical / Q000379:methods*; D005260:Female; D023261:Glasgow Outcome Scale; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D014715:Vertebrobasilar Insufficiency / Q000175:diagnosis / Q000601:surgery*