title: Anterior Transposition of Anomalous Tortuous Vertebral Artery Causing Cervical Radiculopathy: A Report of 2 Cases and Review of Literature.
abstract: OBJECTIVE
  Cervical radiculopathy secondary to compression from vertebral artery (VA) tortuosity is a rare entity. We describe successful transposition through an anterolateral approach of tortuous VA loops causing cervical radiculopathy.
  
  
  METHODS
  Two patients with cervical radiculopathy (first case at C5-6 and second case at C3-4) secondary to anomalous VA loop compression underwent anterolateral approaches to the cervical spine for decompression and VA transposition. The anterior transverse foramina were drilled to unroof the VA loop, which was dissected free from the exiting nerve root.
  
  
  RESULTS
  In both cases, the affected cervical nerve root was successfully decompressed with both radiographic and clinical improvements in radiculopathy symptoms. We found 8 other cases of VA transposition via either an anterolateral approach or a posterolateral approach described in the literature. Our second case of anterolateral VA transposition at the C3-4 level is the first case at this level and the highest level reported in the literature.
  
  
  CONCLUSIONS
  Decompression using an anterolateral approach with direct microvascular transposition of the VA is a safe and effective treatment of this pathology and addresses the cause of radiculopathy more directly than the posterolateral approach.
authors.affiliation: Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA.
authors.forename: Doris D
authors.initials: DD
authors.lastname: Wang
authors.affiliation: Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA.
authors.forename: Jan-Karl
authors.initials: JK
authors.lastname: Burkhardt
authors.affiliation: Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA.
authors.forename: Stephen T
authors.initials: ST
authors.lastname: Magill
authors.affiliation: Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA. Electronic address: Michael.Lawton@ucsf.edu.
authors.forename: Michael T
authors.initials: MT
authors.lastname: Lawton
mesh_terms: D002574:Cervical Vertebrae / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D061145:Microvascular Decompression Surgery / Q000379:methods*; D008875:Middle Aged; D011843:Radiculopathy / Q000000981:diagnostic imaging* / Q000601:surgery*; D014711:Vertebral Artery / Q000002:abnormalities / Q000000981:diagnostic imaging* / Q000601:surgery*
keywords: Anterior spine approach; Foramen transversarium; Microvascular decompression; Radiculopathy; Tortuous vessel; Vertebral artery loop; Vertebral artery transposition