Journal of Craniovertebral Junction and Spine

ORIGINAL ARTICLE
Year
: 2014  |  Volume : 5  |  Issue : 3  |  Page : 122--124

Hemodynamic stroke: A rare pitfall in cranio cervical junction surgery


Jan Frederick Cornelius, Philipp Slotty, Mustafa El Khatib, Richard Bostelmann, Daniel Hanggi, Hans Jakob Steiger 
 Department of Neurosurgery, University Hospital, Heinrich Heine University, Düsseldorf, Germany

Correspondence Address:
Jan Frederick Cornelius
Neurochirurgische Klinik, Universitätsklinik Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf
Germany

Surgical C1C2-stabilization may be complicated by arterial-arterial embolism or arterial injury. Another potential complication is hemodynamic stroke. The latter might be induced in patients with poor posterior fossa collateralization (risk factor 1) when the vertebral artery (VA) is compressed during reduction (risk factor 2). We report a clinical case where this rare situation occurred: A 72-year old patient was undergoing C1C2-stabilization for subluxation due to rheumatoid arthritis. Preoperative computed tomography angiography (CTA) had shown poor collaterals in the posterior fossa. Furthermore, intraoperative Doppler ultrasound (US) detected unilateral VA occlusion during reduction. It appeared to be a high-risk situation for hemodynamic stroke. Surgical inspection of the VA found osteofibrous compressing elements. Arterial decompression was performed resulting in the normal flow as detected by US. Subsequently, C1C2-stabilization could be realized. The clinical and radiological outcome was very favorable. In C1C2-stabilization precise analysis of preoperative CTA and intraoperative US are important to detect risk factors of hemodynamic stroke. Using these data may prevent this rare, but potentially life-threatening complication.


How to cite this article:
Cornelius JF, Slotty P, El Khatib M, Bostelmann R, Hanggi D, Steiger HJ. Hemodynamic stroke: A rare pitfall in cranio cervical junction surgery .J Craniovert Jun Spine 2014;5:122-124


How to cite this URL:
Cornelius JF, Slotty P, El Khatib M, Bostelmann R, Hanggi D, Steiger HJ. Hemodynamic stroke: A rare pitfall in cranio cervical junction surgery . J Craniovert Jun Spine [serial online] 2014 [cited 2020 Apr 7 ];5:122-124
Available from: http://www.jcvjs.com/article.asp?issn=0974-8237;year=2014;volume=5;issue=3;spage=122;epage=124;aulast=Cornelius;type=0