ABSTRACT
Background: Atlas, first cervical vertebra bears sulcus over posterior arch for third part of vertebral artery.Sometimes an osseous bridge converts the sulcus into a foramen called as Arcuate foramen. It is commonlycalled as Kimmerle’s anomaly, also known as Ponticulus Posticus. It is the product of the complete or incompleteossification of the posterior atlanto-occipital membrane over the vertebral artery groove resulting in the formationof a foramen (Arcuate foramen) containing the vertebral artery and the posterior branch of the C-1 spinal nerve.This variation has been associated with vertebro-basilar insufficiency symptoms, various types of headaches,and acute hearing loss. The knowledge of this variant prevents complications during lateral mass screw fixation,posterior laminectomy and endovascular surgery.Aims: The aim of the present study was to analyze the percentage of incidence of arcuate foramen and to identifyits clinical significance.Materials and Methods: Hundred dried human atlas bones were used to study the presence of arcuate foramen inthe department of Anatomy at ESIC Medical College and PGIMSR, Rajajinagar, Bangalore.Results: We came across the presence of arcuate foramen in two out of hundred bones. In both the atlas bones,osseous bridge extending from posterior aspect of superior articular facet to the posterior arch of atlas on theleft side, forming arcuate foramen, posterior to foramen transversarium was observed.Conclusion: Arcuate foramen commonly called as Kimmerle’s anomaly where in a groove for vertebral artery isconverted into a foramen by ossification of the ligament. Awareness of osseous bridging is essential in performingcranio-cervical junction surgeries. It also serves as an anthropological data and also identifying the impact ofcomplete arcuate foramen on the signs and symptoms of vertebra-basilar insufficiency.
ABSTRACT
OBJECTIVE: To investigate the effects of sildenafil citrate (Viagra) on the vertebral artery blood flow of patients with vertebro-basilar insufficiency (VBI) using color duplex sonography (CDS). MATERIALS AND METHODS: The study included 21 patients with VBI (aged 31-76; mean 61.0 +/- 10.5 yrs). We administered a 50 mg oral dose of sildenafil citrate to all patients. Next, we measured the peak systolic velocity (Vmax), end diastolic velocity (Vmin), resistive index (RI), pulsatility index (PI), diameter, area, and flow volume (FV) of vertebral arteries using CDS before the administration of sildenafil citrate; 45 minutes after, and 75 minutes after administration. Statistical testing was performed using SPSS for windows version 11.0. The statistical test used to determine the outcome of the analysis was the repeated measures analysis of variance (ANOVA) test. RESULTS: Compared to the baseline values, the vertebral artery diameter, area, and FV increased significantly following the administration of sildenafil citrate. The diameter, area and FV increased from 3.39 mm at 45 minutes to 3.64 mm at 75 minutes, 9.43 cm2 to 10.80 cm2 at 45 minutes and 10.81 cm2 at 75 minutes, as well as from 0.07 L/min at baseline to 0.09 L/min at 45 minutes and unchanged at 75 minutes, respectively. CONCLUSION: Sildenafil citrate elicited a significant effect on vertebral artery diameter, area and FVs.
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Blood Flow Velocity/drug effects , Piperazines/pharmacology , Pulsatile Flow/drug effects , Purines/pharmacology , Sulfones/pharmacology , Ultrasonography, Doppler, Color , Vascular Resistance/drug effects , Vasodilator Agents/pharmacology , Vertebral Artery/drug effects , Vertebrobasilar Insufficiency/physiopathologyABSTRACT
Objective To Investigate the relationship between an in sertion (I)/deletion (D) polymorphism for angiotensin converting enzyme (ACE) and A(1166)C Polymorphism of angiotensin type 1 receptor(AT 1R) genes in patients with vertebro basilar insufficiency(VBI). Methods In this study, We examined 120 patients with VBI and 146 normal controls. The genotype for I/D of ACE and A(1166)C of AT 1R was assessed using polymerase chain reaction (PCR) and refrained fragment length polymorphism(RFLP), respectively. Then we compared the genotype frequency distribution among subjects.Results As a whole, there was significant difference in the distribution of ACE (I/I, I/D and D/D) and AT 1R (A/A and A/C), respectively. D allele frequency was higher in patients compared with the normal controls. Our study also revealed that Ⅱ AA and DD AA genotype frequency in VBI was higher than that in the normal controls.Conclusion The D allele for ACE and C(1166) allele of AT 1R may correlated with VBI.Ⅱ genotype for ACE and AA genotype had a positive con influence on the VBI. The affection of DD AA genotype on VBI was negative.
ABSTRACT
Objective To evaluate our short term results in endovascular treatment of symptomatic vertebral arteral stenosis with stents. Methods Balloon expanded stents were utilized to pass across the vertebral arterial stenosis, and then the balloons were inflated for the deployment of stents, outcoming with restoration of the stenosis to normal size. Results Forty five patients presented with posterior circulation ischemic symptoms and refractory to medical therapy were undertaken with endovascular stenting, showing technically successful in forty three of them. The mean degrees of preoperative and postoperative stenosis were 75.7% and 10.3%, respectively. Follow up data showed disappearence of clinical symptoms in 35 patients, chinical implovement and stabilization in 2. There were no intimal dissection and distal embolization. Short term follow up angiogram revealed no restenosis and intimal hyperplasia. Conclusions Endovascular stenting may be a favorable alternative for the treatment of vertebral arterial stenosis, but long term follow up is necessary.