https://www.youtube.com/watch?v=5XthXpg28Jg
This is a talk on vertebral artery injury and how to tackle it if it happens during craniovertebral surgery.
In brief, the vertebral artery can be injured in two locations:
- Extraosseous injury (open space injury): The vertebral artery (VA) is vulnerable to injury above the C1 posterior arch and lateral to the atlantoaxial joints. Sometimes there is an anomalous course of the VA that can get injured. Bleeding tends to be torrential; the quickest way to stop it is tamponade for about 20-30 minutes. Endovascular intervention may be required if bleeding cannot be controlled. Ligation or repair of the VA in this region is technically very challenging.
- Intraosseous injury (in the screw hole): The VA is vulnerable to injury in the C2 pars, especially with an anomalous course (high-riding VA). Bleeding can be controlled with bone wax and by inserting the screw. The opposite side has to be abandoned to prevent bilateral VA injury. Postoperative angiography may be needed to assess damage or detect ongoing bleeding.