title: Delayed Hemorrhage from an Iatrogenic Vertebral Artery Injury During Anterior Cervical Discectomy and Successful Endovascular Treatment-Report of a Rare Case and Literature Review.
abstract: BACKGROUND
  Anterior cervical discectomy (ACD) is one of the most common spinal surgeries. Although rare, iatrogenic vertebral artery injuries (VAIs) are potentially life-threatening. Risk factors are anatomic, operative, and pathologic. We report a rare case of iatrogenic VAI during ACD and successful endovascular treatment with no long-term complications. We also review the literature on all VAIs associated with ACD and fusions. Risk factors and the safety and effectiveness of various management modalities are discussed.
  
  
  METHODS
  A 64-year-old patient sustained iatrogenic right VAI during ACD, followed by the delayed formation of a vertebral artery pseudoaneurysm and subsequent rehemorrhage. The patient recovered well with no long-term neurologic sequelae. This case is unusual because the pseudoaneurysm was not apparent on early computed tomography angiography. There is currently no consensus regarding the appropriate intraoperative management for iatrogenic VAIs. Described treatment modalities include direct repair, tamponade, and endovascular procedures.
  
  
  CONCLUSIONS
  Delayed pseudoaneurysm formation after iatrogenic VAI can occur. Endovascular embolization can be a safe treatment alternative to surgical repair.
authors.affiliation: Department of Neurosurgery, University Hospital, Coventry, United Kingdom. Electronic address: williamlo@doctors.org.uk.
authors.forename: William B
authors.initials: WB
authors.lastname: Lo
authors.affiliation: Department of Neuroradiology, University Hospital, Coventry, United Kingdom.
authors.forename: Sanjoy
authors.initials: S
authors.lastname: Nagaraja
authors.affiliation: Department of Neurosurgery, University Hospital, Coventry, United Kingdom.
authors.forename: Amar
authors.initials: A
authors.lastname: Saxena
mesh_terms: D017541:Aneurysm, False / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D002533:Cerebral Angiography; D002574:Cervical Vertebrae / Q000601:surgery*; D000072226:Computed Tomography Angiography; D017586:Diskectomy / Q000009:adverse effects*; D057510:Endovascular Procedures; D006801:Humans; D007049:Iatrogenic Disease; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D013123:Spinal Fusion / Q000009:adverse effects*; D013997:Time Factors; D014711:Vertebral Artery / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery
keywords: Anterior cervical approach; Complication; Endovascular embolization; Hemorrhage; Iatrogenic injury; Pseudoaneurysm; Vertebral artery