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61. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC) im Rahmen der Neurowoche 2010
Joint Meeting mit der Brasilianischen Gesellschaft für Neurochirurgie am 20. September 2010

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

21. - 25.09.2010, Mannheim

Prospective evaluation of vertebral artery injury after blunt cervical spine injury

Meeting Abstract

  • Christian-Andreas Mueller - Klinik und Poliklinik für Neurochirurgie, Rheinische Friedrich-Wilhelms Universität Bonn, Deutschland
  • Rudolf Andreas Kristof - Klinik und Poliklinik für Neurochirurgie, Rheinische Friedrich-Wilhelms Universität Bonn, Deutschland
  • Inga Peters - Klinik und Poliklinik für Neurochirurgie, Rheinische Friedrich-Wilhelms Universität Bonn, Deutschland
  • Martin Podlogar - Klinik und Poliklinik für Neurochirurgie, Rheinische Friedrich-Wilhelms Universität Bonn, Deutschland
  • Attila Kovacs - Klinik für Radiologie und Neuroradiologie, Rheinische Friedrich-Wilhelms Universität Bonn, Deutschland
  • Thomas Kral - Klinik und Poliklinik für Neurochirurgie, Rheinische Friedrich-Wilhelms Universität Bonn, Deutschland; Abteilung für Neurochirurgie, Gemeinschaftskrankenhaus Herdecke/Ruhr, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 61. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC) im Rahmen der Neurowoche 2010. Mannheim, 21.-25.09.2010. Düsseldorf: German Medical Science GMS Publishing House; 2010. DocV1531

DOI: 10.3205/10dgnc008, URN: urn:nbn:de:0183-10dgnc0084

Veröffentlicht: 16. September 2010

© 2010 Mueller et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

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Objective: Vertebral artery injuries (VAI) due to spine injuries are thought to be rarely symptomatic and can be easily overlooked. VAI have the potential to cause cerebral and spinal cord ischemia. In this prospective observational study VAI following cervical spinal injuries were diagnosed and managed according to a standardized protocol, as described previously by Kral et al. (Zentralbl Neurochir, 2002).

Methods: During a 16 year period 69 (mean age: 43y, SD±20.71; 25 female, 44 male, p<0.05) of 599 patients with blunt cervical spine injury were suspicious for VAI due to facet luxation and/or fractures extending in the transverse foramen, and were subjected to a predefined radiological work-up. Digital subtraction angiography (DSA) was performed in all patients. Additionally, 15 magnetic resonance angiographies (MRA) and 7 computed tomography angiographies (CTA) were performed. Injury grading of VAI was done according to Biffl et al. (Ann Surg, 2000).

Results: In cases suspicious for VAI the incidence of VAI detected by DSA was 27.5% (n=19 of 69). VAI Grade I occurred in 15.8% (n=3), Grade II in 26.31% (n=5), Grade IV in 52.6% (n=10), and in one case Grade V with a rupture of one VA. MRA failed to detect a VAI (Grade I) in one patient, while CTA detected the VAI in all cases. 4 of 19 patients (21%) had clinical signs of vertebrobasilar insufficiency. Two patients with unilateral PICA and PCA infarctions became comatose and ultimately died after several days. One patient had vertigo and headache due to unilateral PICA Infarction, and one patient had vertigo due to unilateral VA occlusion. All patients with VAI were treated with anticoagulation (Heparin followed by ASS) for 6 month without adverse effects. 33 of 69 patients (47.8%) with VAI had unstable spine injuries and were treated surgically.

Conclusions: In patients with cervical spine fractures or dislocations crossing the course of the vertebral artery, VAI are frequent and are associated with significant morbidity and mortality. VAI were indentified by DSA in every fourth case. Despite anticoagulation therapy, every fifth patient becomes clinically symptomatic due to cerebrovascular insufficiency that leads to death in every tenth patient.