Akademik Veri Yönetim Sistemi
EANS2024 Sofia Congress, Sofija, Bulgaristan, 13 - 17 Ekim 2024, ss.11, (Özet Bildiri)
Introduction: Cervical spine surgery is a complex procedure associated with various intraoperative complications. One rare yet severe complication is iatrogenic vertebral artery injury, posing significant risks of mortality and morbidity. Treatment options for this injury encompass surgical tamponade, endovascular interventions, temporary ligation, and direct repair. Herein we present a case with intraoperative vertebral artery injury, which was treated with hemostatic agents in acute setting followed by endovascular ligation.
Case report: A 41-year-old female patient presented with neck and right upper extremity pain. Her cervical magnetic resonance imaging (MRI) reveled right sided C6-7 disc herniation. Her neurological examination showed a muscle strength of 3/5 in the right triceps and interosseous muscles. The decision was made to perform microscopic discectomy using a posterior cervical approach. We opted for the posterior cervical approach due to the lateral positioning and the presence of a soft component in the disk herniation. While attempting to extract a disc fragment from the lateral aspect of the disc space using a punch rongeur, a significant bleeding episode occurred due to damage to the right vertebral artery.Temporary hemostasis was achieved using gelatinous hemostatic agents. The patient was urgently taken for endovascular intervention. It was observed that the left vertebral artery was dominant with sufficient collaterals. Antegrade and retrograde coil embolization procedures were performed on the right vertebral artery. The patient, observed in the postoperative intensive care unit, was noted to have relieved of radicular pain, and her neurological examination improved.
Conclusion: This case underscores the successful application of rapid and effective endovascular intervention when faced with iatrogenic vertebral artery injury.In conclusion, adopting a multidisciplinary approach in the treatment of iatrogenic vertebral artery injuries and enhancing surgical teams' skills in managing such emergencies are essential.