Abstract
BackgroundThe vertebral artery (VA) forms the caudal part of the circle of Willis and is responsible for one-third of the blood supply of the cerebellum, pons, middle ear, and the upper part of the spinal cord and its meninges. The highest potential risk of injury to VA during cervical pedicle screw implantation is at C3 and then at C6. Knowledge about the morphometry of VA provides a better understanding of clinical conditions such as vertebra basilar insufficiency (VBI). Similarly, the knowledge of variation in the VA is needed during cervical pedicle screw implantation, which possesses the highest potential risk to VA at the C3 level. The origin of the vertebral artery from the aortic arch reached the upper cervical vertebra than the vertebral artery of subclavian origin. The length of the VA is greater on the left side than the right-side artery. Understanding and reporting of the same are essential to creating awareness that can aid in endarterectomy, angioplasty, and radiological procedures. Variations are noted in morphometry between sides.AimTo determine the morphometry of the vertebral artery (VA) with emphasis on the fourth segment (V4) and its variations using computed tomography angiogram (CTA).Materials and methodsThis present retrospective study was conducted in the Departments of Anatomy and Radiology and Imaging Sciences, Saveetha Medical College and Hospital. Participants were patients who took a head and neck CT for various clinical reasons. About 50 CT images, 33 male and 17 females, were selected from the archives. The length, diameter, and entry level of VA were studied. The data were tabulated and statistically analyzed.ResultThe mean length of VA was 24.49 ± 3.02 (cm) on the left side and 24.28 ± 3.91 (cm) on the right side in female subjects and was found to be 22.78 ± 1.7 (cm) on the left side and 21.5 ± 2.7 (cm) on the right side in male subjects. The mean diameter of VA at the level of the foramen magnum was 0.32 ± 0.05 (cm) on the right side and 0.322 ± 0.07 (cm) on the left side in females, 0.3 ± 0.064 (cm) on the left side and 0.26 ± 0.086 (cm) on the right side in males.ConclusionThe length of VA was found to be statistically more on the left side than on the right side. The variations in morphometry seen can aid in various surgical and radiological procedures.
Highlights
Syncope is the clinical manifestation in the posterior cerebral artery occlusion or temporary sludge flow in the vertebral artery (VA)
Knowledge about the morphometry of VA provides a better understanding of clinical conditions such as vertebra basilar insufficiency (VBI)
The right vertebral artery had its origin from the subclavian artery and entered the foramen transversarium at the level of C6 in 44 cases (88%), whereas in six cases (12%), the left VA originated from the arch of the aorta and entered the foramen transversarium at the level of C5
Summary
Syncope is the clinical manifestation in the posterior cerebral artery occlusion or temporary sludge flow in the vertebral artery (VA). The initial segment of the vertebral artery (V1) ascends to enter the transverse foramen (TF) of the six cervical vertebrae (V2). It ascends through the transverse foramina of C6-C1, which runs posterolaterally around the atlas (V3). It penetrates the dura mater and passes through the foramen magnum to become the intracranial segment of the vertebral artery (V4) [6,7]. The knowledge of variation in the VA is needed during cervical pedicle screw implantation, which possesses the highest potential risk to VA at the C3 level.
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