title: Three-dimensional computed tomography angiographic study of the vertebral artery in patients with congenital craniovertebral junction anomalies.
abstract: To describe vertebral artery (VA) course at the C0-C1-C2 complex in patients with congenital bony craniovertebral junction (CVJ) anomalies.
  
  
  
  We studied the course of 169 VAs in 86 patients with congenital bony CVJ anomalies [basilar invagination (42), os odontoideum (33), and irreducible atlantoaxial dislocation (11)]. Occipitalized atlas occurred in 41 patients (30 complete and 11 partial). Using axial, coronal and sagittal three-dimensional computed tomography (3D-CT) angiograms, we traced the VA bilaterally at the CVJ and correlated the course to the presence or absence of occipitalization of the atlas.
  
  
  
  Of the 73 arteries associated with occipitalization of atlas, all had an abnormal course-58 (78.4 %) coursed through a canal within the C0-C1 fused complex and 15 (20.3 %) coursed below the C1 posterior arch, and it was absent unilaterally in one patient. There were 96 arteries associated with a non-occipitalized atlas and only 15 (15.3 %) were abnormal-eight coursed below the C1 posterior arch, four coursed above the C1 arch in the absence of a C1 foramen transversarium, one passed through a canal in C0-C1 and two arteries were absent unilaterally. Sixty vertebral arteries (34 on the right and 26 on the left side) had a redundant loop situated at a distance of ≥5 mm from the C1 lateral mass in patients with os odontoideum and irreducible atlantoaxial dislocation.
  
  
  
  In occipitalization of the atlas, the VA course is usually abnormal-typically passing through a canal within the C0-C1 fused complex or below the C1 arch. A redundant VA loop is more likely to be seen in os odontoideum and irreducible atlantoaxial dislocation. Careful study of the vertebral artery course with 3D CT angiography is mandatory while contemplating CVJ realignment surgery in congenital anomalies of the CVJ.
authors.affiliation: Department of Neurological Sciences, Christian Medical College, Vellore, India. laxminadh.sivaraju@gmail.com.
authors.forename: Laxminadh
authors.initials: L
authors.lastname: Sivaraju
authors.affiliation: Department of Radiodiagnosis, Christian Medical College, Vellore, India.
authors.forename: Sunithi
authors.initials: S
authors.lastname: Mani
authors.affiliation: Department of Neurological Sciences, Christian Medical College, Vellore, India.
authors.forename: Krishna
authors.initials: K
authors.lastname: Prabhu
authors.affiliation: Department of Neurological Sciences, Christian Medical College, Vellore, India.
authors.forename: Roy Thomas
authors.initials: RT
authors.lastname: Daniel
authors.affiliation: Department of Neurological Sciences, Christian Medical College, Vellore, India.
authors.forename: Ari George
authors.initials: AG
authors.lastname: Chacko
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001268:Atlanto-Axial Joint / Q000002:abnormalities / Q000000981:diagnostic imaging*; D001269:Atlanto-Occipital Joint / Q000002:abnormalities / Q000000981:diagnostic imaging*; D001368:Axis, Cervical Vertebra; D001270:Cervical Atlas; D002574:Cervical Vertebrae; D002648:Child; D000072226:Computed Tomography Angiography; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D004204:Joint Dislocations / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D014711:Vertebral Artery / Q000002:abnormalities / Q000000981:diagnostic imaging*; D055815:Young Adult
keywords: Atlantoaxial dislocation; Basilar invagination; Computed tomography angiography; Craniovertebral junction; Vertebral artery