title: Hemodynamic stroke: A rare pitfall in cranio cervical junction surgery.
abstract: Surgical C1C2-stabilization may be complicated by arterial-arterial embolism or arterial injury. Another potential complication is hemodynamic stroke. The latter might be induced in patients with poor posterior fossa collateralization (risk factor 1) when the vertebral artery (VA) is compressed during reduction (risk factor 2). We report a clinical case where this rare situation occurred: A 72-year old patient was undergoing C1C2-stabilization for subluxation due to rheumatoid arthritis. Preoperative computed tomography angiography (CTA) had shown poor collaterals in the posterior fossa. Furthermore, intraoperative Doppler ultrasound (US) detected unilateral VA occlusion during reduction. It appeared to be a high-risk situation for hemodynamic stroke. Surgical inspection of the VA found osteofibrous compressing elements. Arterial decompression was performed resulting in the normal flow as detected by US. Subsequently, C1C2-stabilization could be realized. The clinical and radiological outcome was very favorable. In C1C2-stabilization precise analysis of preoperative CTA and intraoperative US are important to detect risk factors of hemodynamic stroke. Using these data may prevent this rare, but potentially life-threatening complication.
authors.affiliation: Department of Neurosurgery, University Hospital, Heinrich Heine University, Düsseldorf, Germany.
authors.forename: Jan Frederick
authors.initials: JF
authors.lastname: Cornelius
authors.affiliation: Department of Neurosurgery, University Hospital, Heinrich Heine University, Düsseldorf, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Slotty
authors.affiliation: Department of Neurosurgery, University Hospital, Heinrich Heine University, Düsseldorf, Germany.
authors.forename: Mustafa
authors.initials: M
authors.lastname: El Khatib
authors.affiliation: Department of Neurosurgery, University Hospital, Heinrich Heine University, Düsseldorf, Germany.
authors.forename: Richard
authors.initials: R
authors.lastname: Bostelmann
authors.affiliation: Department of Neurosurgery, University Hospital, Heinrich Heine University, Düsseldorf, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Hänggi
authors.affiliation: Department of Neurosurgery, University Hospital, Heinrich Heine University, Düsseldorf, Germany.
authors.forename: Hans Jakob
authors.initials: HJ
authors.lastname: Steiger
keywords: Atlanto-axial instability; bow hunter's syndrome; cranio cervical junction; doppler ultrasound; skull base; vertebral artery; vertebro-basilar insufficiency