title: Multimodality management of vertebral artery injury sustained during cervical or craniocervical surgery.
abstract: BACKGROUND
  Iatrogenic vertebral artery (VA) injury is a rare but potentially devastating complication associated with cervical and craniocervical surgery.
  
  
  OBJECTIVE
  To retrospectively evaluate treatment modalities and outcomes associated with iatrogenic VA injury.
  
  
  METHODS
  Our institutional surgical database was queried for patients who underwent cervical or craniocervical surgery from January 1997 to August 2012.
  
  
  RESULTS
  During this time period, 8213 patients underwent cervical or craniocervical surgery, and 17 (0.2%) cases of VA injury were identified. Eight (47%) of these injuries occurred during C1-2 instrumentation procedures. Primary microsurgical repair of the VA was performed in 5 patients. Other cases were managed by either surgical or endovascular VA occlusion. Of the 17 patients, 15 underwent immediate angiography, 9 of whom were ultimately treated by the use of endovascular techniques.
  
  
  CONCLUSIONS
  VA injury is an uncommon complication of cervical and/or skull base surgery. Standardized management recommendations may help reduce complications associated with these rare but potentially devastating injuries.
authors.affiliation: Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.
authors.forename: Peter Hanks
authors.initials: PH
authors.lastname: Maughan
authors.forename: Andrew F
authors.initials: AF
authors.lastname: Ducruet
authors.forename: Ali M
authors.initials: AM
authors.lastname: Elhadi
authors.forename: Nikolay L
authors.initials: NL
authors.lastname: Martirosyan
authors.forename: Mark
authors.initials: M
authors.lastname: Garrett
authors.forename: Raza
authors.initials: R
authors.lastname: Mushtaq
authors.forename: Felipe C
authors.initials: FC
authors.lastname: Albuquerque
authors.forename: Nicholas
authors.initials: N
authors.lastname: Theodore
mesh_terms: D000328:Adult; D000368:Aged; D002533:Cerebral Angiography; D002561:Cerebrovascular Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D002574:Cervical Vertebrae / Q000601:surgery; D002675:Child, Preschool; D003131:Combined Modality Therapy / Q000379:methods; D016208:Databases, Factual / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000009:adverse effects*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D015898:Tomography Scanners, X-Ray Computed; D014711:Vertebral Artery / Q000293:injuries*; D055815:Young Adult