This case report describes a 40-year-old male who presented with chronic neck pain radiating to the left upper limb, associated with weakness and numbness. He also had symptoms of vertebrobasilar insufficiency. Imaging revealed an intraneural foramen vertebral artery (VA) loop compressing the C3 nerve root. Conservative management was ineffective, prompting surgical decompression via a left C2-C3 facetectomy and foraminotomy. The patient experienced immediate pain relief and gradual improvement in weakness, with complete resolution of symptoms at the six-month follow-up. This case highlights the potential for VA loops to cause radiculopathy and the successful use of surgical decompression for treatment.

Previous studies have reported various anatomical differences in the cerebral artery between healthy subjects and patients with posterior circulation cerebral infarction. In particular, basilar artery angulation has been associated with posterior circulation cerebral infarction. We compared anatomical variations and the degree of anterior and lateral vertebrobasilar artery angulation and deviation to compare the incidence of cerebral infarction of healthy subjects and patients with posterior circulation cerebral infarction. We compared basilar artery anatomy using brain magnetic resonance angiography in 97 patients who underwent brain magnetic resonance angiography during health checkups at our hospital and in 92 patients diagnosed with posterior circulation cerebral infarction between 2012 and 2022. Anatomical variations, including fetal-type posterior cerebral artery, hypoplastic P1 segment, vertebrobasilar dolichoectasia, and dominant vertebral artery, as well as the degree of anterior and lateral deviation and angulation, were evaluated. Correlations between these variations and the occurrence of cerebral infarction were analyzed. The prevalence of hypoplastic P1 was significantly differences in patients with posterior circulation cerebral infarction (odds ratio: 5.655). Furthermore, patients with posterior circulation cerebral infarction exhibited more acute anterior and lateral angulation, as well as lateral deviation. Hypoplastic P1 and more acute anterior or lateral angulation of the vertebrobasilar artery are associated with increased frequency of cerebral infarction.

BACKGROUND: Spinal cord infarction is an uncommon nervous system disorder. We present a case of high cervical cord infarction caused by stenting of the origin of the left vertebral artery (VA). The incidence of spinal cord infarction is minimal, and it must be distinguished from a number of other disorders. The diagnosis is primarily based on imaging, clinical symptoms, and history. Currently, there is no focused treatment for spinal cord infarction. Thrombolysis, high-dose glucocorticoid shocks, tube dilatation to promote circulation, and nutritional neurotropic medicines given early in the course of the disease can all help to slow the disease\'s progression. There is no agreement on the etiology, diagnosis, or therapy options for these people.
METHODS: On October 7, 2023, an 81-year-old man was admitted to the hospital primarily for recurrent chest tightness and pain that had persisted for more than 2 years and 1 month. Cerebral angiography upon admission revealed significant blockage of the right VA and stenosis of the left vertebral arterial origin. Six days following admission, a drug-eluting stenting procedure was carried out under local anesthesia to open the left VA origin via the femoral artery. Following the procedure, the patient experienced a progressive loss of muscle strength in all 4 limbs and paraplegia below the cervical 3 spinal cord. One week following the procedure, the patient was released from the hospital. After the procedure, the patient was released 1 week later. After the procedure, the patient\'s symptoms persisted for a month.
CONCLUSIONS: High awareness for high cervical cord infarction is required when neck discomfort and limb weakness with progressive progression arises after surgery. Complications of high cervical cord infarction following stenting for stenosis of VA origin are uncommon in clinical settings. Patients\' prognoses can be improved by prompt diagnosis and care.

BACKGROUND Vertebral artery origin stenosis (VAOS) has recently gained increased attention, with endovascular treatments like stent implantation showing high success and low complication rates, although less is known about VAOS compared to carotid artery stenosis. This study evaluated the safety and effectiveness of transradial (TRA) and transfemoral (TFA) approaches for VAOS stent placement. MATERIAL AND METHODS We recruited a total of 102 patients undergoing vertebral artery stenting in our hospital between January 2020 and November 2022. Patients were randomly assigned to undergo either radial or femoral approach for stent implantation in the vertebral artery, and the radial approach group secondary divided into 2 groups by patients\' consent: ipsilateral or contralateral radial approach. The success rates of VAOS stent implantation, operation time, and postoperative hospitalization time were compared between the 3 groups. In addition, we compared the outcomes of stroke within 30 days, transient ischemic attack (TIA) within 30 days, and other indicators. RESULTS Of the 102 patients, the final success rate of stent implantation was not significantly different between the 3 groups. The time from sheath insertion to stent insertion in the ipsilateral TRA group (median time: 19 min [interquartile range (IQR): 12-24.5 min]) was significantly shorter than in the transfemoral approach (TFA) group (median time: 29 min [IQR: 21-35.5 min]) (P<0.01; 95% confidence interval (95% CI): 10 min [6-14 min]). There were no statistically significant differences between the 3 groups in terms of cerebrovascular events within 1 month, and patient satisfaction and preference favored the radial approach. CONCLUSIONS The postoperative hospitalization time and operation time associated with the ipsilateral TRA were shorter, and patient acceptance and satisfaction were higher.

METHODS: A prospective study.
OBJECTIVE: To investigate the incidence of vertebral artery (VA) occlusion and whether anterior spinal artery (ASA) is occluded in cervical facet dislocation.
METHODS: University hospital, China.
METHODS: During a 2-year period, 21 conventional patients with cervical facet dislocation were prospectively enrolled. All patients received computed tomography angiography (CTA) to assess the patency of the VA, anterior radiculomedullary arteries (ARAs), and ASA at the time of injury. Clinical data were documented, including demographics, symptomatic vertebrobasilar ischemia, American Spinal Injury Association Impairment Scale (ASIA) grades, and ASA and VA radiological characteristics.
RESULTS: VA unilateral occlusion occurred in 5 of 21 patients (24%), including 2 with unilateral facet dislocation and 3 with bilateral facet dislocation. No ASA occlusion was found in all 21 patients, including 5 with VA unilateral occlusion. No patients had symptomatic vertebrobasilar ischemia.
CONCLUSIONS: VA occlusion occurs in approximately one-fourth of cervical facet dislocations, with infrequent symptomatic vertebrobasilar ischemia. ASA is not occluded following cervical facet dislocation, even with unilateral VA occlusion.

UNASSIGNED: Spinal aneurysms rarely occur in the collateral circulation of the vertebral artery (VA). These aneurysms are difficult to treat. A flow diverter (FD) can be a therapeutic option.
METHODS: A 62-year-old man suffered subarachnoid hemorrhage. His Hunt-Hess scale classification was grade II. Digital subtraction angiography (DSA) revealed that the bilateral distal VAs were occluded, there were two flow-related aneurysms in the collateral circulation of the first radicular artery of the VA, and there was a dissecting aneurysm at the origin of the posterior inferior cerebellar artery (PICA). The FD covered the PICA dissecting aneurysm, and the first radicular artery originated in the VA. Postoperatively, computed tomography angiography revealed a patent PICA and regression of the aneurysm in the collateral circulation. At the one-month follow-up, he showed good recovery and was therefore allowed to return to work. Follow-up DSA confirmed the regression of the aneurysms. However, the intracranial VA and PICA were unexpectedly occluded.
UNASSIGNED: It is difficult to catheterize aneurysms in the collateral circulation to perform coiling. It is also dangerous to embolize such aneurysms with a liquid embolic agent. After FD deployment to cover the origin of the parent artery, the hemodynamic stress of the aneurysm decreases, and the aneurysm can regress.
CONCLUSIONS: Aneurysms in the collateral circulation were not accessible. FD deployment in the parent artery to cover the origin of the feeding artery of the collateral circulation is feasible for treating such aneurysms.

BACKGROUND: Innominate artery aneurysms (IAAs) are rare and may result in rupture, distal arterial embolization, or local compression without timely treatment. Rupture is the most dangerous of these complications. This article reports a case of innominate artery bifurcation pseudoaneurysm.
METHODS: The patient was a 45-year-old man who was admitted to the emergency department due to chest discomfort. The computed tomographic angiography (CTA) imaging indicated the presence of a 3.6*2.4 cm saccular aneurysm in the bifurcation of the innominate artery, involving both the right proximal subclavian and common carotid arteries. The patient\'s vital signs were normal, there was equal blood pressure in the upper arms and no neurological dysfunction was observed. Gadolinium-enhanced magnetic resonance angiography indicated that the circle of Willis was intact. The treatment involved open surgery combined with endovascular therapy. The external carotid artery was first transposed to the right subclavian artery (RSA) and an 8-mm woven Dacron graft was inserted in the middle. The covered stent graft was then placed in the proximal part of the innominate artery to close the entrance of the aneurysm. Lastly, an occluder was implanted at the origin of the RSA. There were no perioperative or postoperative complications. At 1-year follow-up, no aneurysm was observed on CTA and the right vertebral artery was patent.
CONCLUSIONS: This study indicated that the combined use of endovascular therapy and open repair surgery is an effective strategy to treat innominate artery bifurcation pseudoaneurysm.

BACKGROUND: Bow Hunter\'s syndrome (BHS), also known as rotational vertebral artery occlusion (RVAO), is a rare condition characterized by dynamic vertebrobasilar insufficiency due to position-dependent occlusion of the vertebral artery (VA). In the existing literature, most cases of BHS are attributed to osteophytic compression originating from the occipital condyle or within the transverse foramen, often accompanied by anatomical abnormalities of the VA. However, cases presenting solely with VA anomalies in the absence of any cervical vertebral structural abnormality are rare. This case report presents a unique instance of BHS in a 56-year-old male, attributed to the anomalous origin of the right VA and the absence of the left VA, without cervical structural abnormalities.
METHODS: The patient exhibited symptoms like episodic dizziness and vertigo, which were exacerbated by rightward head rotation and alleviated upon returning to a neutral position. Diagnostic evaluation, including digital subtraction angiography, revealed that the right VA originated from the right common carotid artery and compression-induced stenosis of the right VA during head rotation. Conservative management, including avoidance of certain head movements and anti-arteriosclerosis medication, led to symptom resolution over a two-year follow-up period.
CONCLUSIONS: This report contributes to the understanding of BHS by highlighting a rare vascular anomaly presentation and incorporates a review of 14 similar case reports in the literature describing that an anatomical abnormality of the VA is mainly responsible for the pathology of BHS in the absence of cervical vertebral anomalies, thus emphasizing the need for careful diagnostic and management strategies.

The International Subarachnoid Aneurysm Trial led to a shift from clipping to endovascular coiling as the primary therapy for cerebral aneurysm particularly in the management of posterior circulation aneurysm. However, endovascular therapy is often unavailable in low-resource settings, emphasizing the importance of maintaining surgical skill sets in resource-poor countries. This article presents a detailed case report on the successful microneurosurgical management of a 65-year-old female with a history of headache and weakness with past history of hypertension and a right posterior cerebral artery territory infarct who was diagnosed with a ruptured aneurysm situated within the intracranial vertebral artery. Patient was operated with the far lateral approach and clipping of the aneurysm. This case report elucidates the intricate surgical techniques employed, and the challenges neurosurgeons encountered in treating posterior circulation intracranial aneurysms, particularly those with ruptured complications. The aneurysms\' intricate anatomy and increased rupture risk necessitate a meticulous microneurosurgical approach. The severity of subarachnoid hemorrhage from ruptured aneurysms increases morbidity and mortality rates.

Objective  While the transcondylar approach is technically challenging, it provides generous ventral and caudal exposure to the craniovertebral junction. This approach requires navigation around multiple eloquent neurovascular structures including the lower cranial nerves, vertebral artery and its branches, and the brainstem. Superficial exposure, including incision location and muscle dissection, can dramatically affect the surgical angle and maneuverability at depth. Methods  We demonstrate the transcondylar approach in a step-by-step fashion in a formalin-embalmed, latex-injected cadaver head. Dissection within each layer of the suboccipital muscles was performed. A small cohort with an illustrative case is also included herein. Results  The sternocleidomastoid (SCM) muscle was retracted anteriorly; the splenium capitis, semispinalis capitis, and longissimus capitis muscles were disconnected from the superior nuchal line and reflected inferomedially. The suboccipital muscle group was fully exposed. The superior and inferior oblique muscles were disconnected from the transverse process of C1. The superior oblique and the rectus capitis posterior major muscles were then dissected off the inferior nuchal line, and the suboccipital muscle group was retracted inferomedially en bloc . The greater auricular nerve was retracted laterally with the SCM, and the greater occipital nerve was retracted inferomedially with the suboccipital muscle group. Conclusion  This technique avoids the obstructive muscle bulk that results from a myocutaneous approach while maximizing deep exposure. Understanding the detailed muscular anatomical relationship with the insertion location and suboccipital nerves is key to complete and safe extracranial dissection. Diligent dissection helps minimize postoperative pain and muscle spasm while optimizing the closure technique.