title: Usefulness of Intraoperative Monitoring during Microsurgical Decompression of Cervicomedullary Compression Caused by an Anomalous Vertebral Artery.
abstract: We report a case of cervicomedullary compression by an anomalous vertebral artery treated using microsurgical decompression with intraoperative monitoring. A 68-year-old woman presented with posterior neck pain and gait disturbance. MRI revealed multiple abnormalities, including an anomalous vertebral artery that compressed the spinal cord at the cervicomedullary junction. Suboccipital craniectomy with C1 laminectomy was performed. The spinal cord was found to be compressed by the vertebral arteries, which were retracted dorsolaterally. At that time, the somatosensory evoked potential (SSEP) changed. After release of the vertebral artery, the SSEP signal normalized instantly. The vertebral artery was then lifted gently and anchored to the dura. There was no other procedural complication. The patient's symptoms improved. This case demonstrates that intraoperative monitoring may be useful for preventing procedural complications during spinal cord microsurgical decompression.
authors: Department of Neurosurgery, Busan Paik Hospital, Inje University School of Medicine, Busan, Korea.
authors: Sung Tae
authors: ST
authors: Kim
authors: Department of Neurosurgery, Busan Paik Hospital, Inje University School of Medicine, Busan, Korea.
authors: Sung Hwa
authors: SH
authors: Paeng
authors: Department of Neurosurgery, Busan Paik Hospital, Inje University School of Medicine, Busan, Korea.
authors: Dong Mun
authors: DM
authors: Jeong
authors: Department of Neurosurgery, Busan Paik Hospital, Inje University School of Medicine, Busan, Korea.
authors: Kun Soo
authors: KS
authors: Lee
keywords: Cervicomedullary junction; Intraoperative monitoring; Microvascular decompression; Vertebral artery
references: J Neurosurg. 1993 Aug;79(2):283-5
references: 8331414
references: No Shinkei Geka. 1998 Jan;26(1):45-50
references: 9488991
references: J Neurosurg. 2002 Jan;96(1):140-3
references: 11794596
references: No Shinkei Geka. 1993 Nov;21(11):1035-8
references: 8255379
references: Spine (Phila Pa 1976). 2010 Jul 15;35(16):E782-6
references: 20581755
references: Evid Based Spine Care J. 2013 Apr;4(1):42-53
references: 24436698
references: Spine (Phila Pa 1976). 1996 Oct 1;21(19):2280-3
references: 8902976
references: Clin Orthop Relat Res. 1977 Jul-Aug;(126):100-5
references: 598095
references: AJNR Am J Neuroradiol. 1986 Jan-Feb;7(1):55-60
references: 3082144
references: Br J Neurosurg. 1990;4(2):147-54
references: 2357284
references: Spine (Phila Pa 1976). 2008 Aug 1;33(17):E611-3
references: 18670330
references: Clin Neurophysiol. 2008 Feb;119(2):248-64
references: 18053764
references: Neurosurgery. 1999 Mar;44(3):520-7; discussion 527-8
references: 10069589
references: Surg Neurol Int. 2011;2:103
references: 21886876
references: No Shinkei Geka. 1988 Sep;16(10):1173-7
references: 3205359
references: J Neurosurg. 2001 Jul;95(1 Suppl):146-9
references: 11453419
references: Clin Neurol Neurosurg. 1997 Feb;99(1):56-9
references: 9107470
references: J Neurosurg. 1998 Sep;89(3):485-8
references: 9724128
references: No To Shinkei. 2002 May;54(5):435-9
references: 12058415
references: Neurophysiol Clin. 2007 Dec;37(6):407-14
references: 18083496
references: Eur Spine J. 2012 Jun;21 Suppl 4:S505-8
references: 22237850
references: Neurol Med Chir (Tokyo). 2001 Jun;41(6):322-4
references: 11458746
references: Electroencephalogr Clin Neurophysiol. 1990 Mar-Apr;77(2):137-9
references: 1690114
references: Neurology. 2003 Dec 23;61(12 ):1736-42
references: 14694039
references: Spine (Phila Pa 1976). 2003 Jun 1;28(11):1183-8
references: 12782990
references: No Shinkei Geka. 1999 Jul;27(7):645-50
references: 10440039
references: J Neurosurg. 1990 Sep;73(3):375-82
references: 2384775