Ahead of Print: Management of Iatrogenic VA Injury

Screen Shot 2013-06-11 at 2.51.50 PMBackground: Iatrogenic vertebral artery (VA) injury is a rare but potentially devastating complication associated with cervical and craniocervical surgery.

Objective: To retrospectively evaluate treatment modalities and outcomes associated with iatrogenic VA injury.

Methods: Our institutional surgical database was queried for patients who underwent cervical or craniocervical surgery from 1/1997 to 8/2012.

Results: 8213 patients underwent cervical or craniocervical surgery during this time period and 17 (0.2%) cases of VA injury were identified. Eight (47%) of these injuries occurred during C1-2 instrumentation procedures. Primary microsurgical repair of the VA was performed in 5 patients. Other cases were managed by either surgical or endovascular VA occlusion. Of the 17 patients, 15 underwent immediate angiography, nine of whom were ultimately treated using endovascular techniques.

Conclusion: VA injury is an uncommon complication of cervical and/or skull base surgery. Standardized management recommendations may help reduce complications associated with these rare but potentially devastating injuries.

From: Multimodality Management of Vertebral Artery Injury Sustained During Cervical or Craniocervical Surgery by Maughan et al.

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