Purpose

Our goals are (1) to report a consecutive prospective series of children who had posterior circulation stroke caused by vertebral artery dissection at the V3 segment; (2) to describe a configuration of the vertebral artery that may predispose to rotational compression; and (3) to recommend a new protocol for evaluation and treatment of vertebral artery dissection at V3.

Methods

All children diagnosed with vertebral artery dissection at the V3 segment from September 2014 to July 2020 at our institution were included in the study. Demographic, clinical, surgical, and radiological data were collected.

Results

Sixteen children were found to have dissection at a specific segment of the vertebral artery. Fourteen patients were male. Eleven were found to have compression on rotation during a provocative angiogram. All eleven underwent C1C2 posterior fusion as part of their treatment. Their mean age was 6.44 years (range 18 months–15 years). Mean blood loss was 57.7 mL. One minor complication occurred: a superficial wound infection treated with oral antibiotics only. There were no vascular or neurologic injuries. There have been no recurrent ischemic events after diagnosis and/or treatment. Mean follow-up was 33.3 months (range 2–59 months). We designed a new protocol to manage V3 dissections in children.

Conclusion

Posterior C1C2 fusion is a safe and effective option for treatment of dynamic compression in vertebral artery dissection in children. Institution of and compliance with a strict diagnostic and treatment protocol for V3 segment dissections seem to prevent recurrent stroke.

中文翻译：

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儿童椎动脉解剖中的动态压缩：一项新方案的建议

目的

我们的目标是（1）报告在V3段连续发生的因椎动脉解剖引起的后循环中风的儿童；（2）描述可能易于旋转压缩的椎动脉构型；（3）推荐用于评估和治疗V3椎动脉解剖的新方案。

方法

2014年9月至2020年7月在我们机构诊断为V3段椎动脉夹层的所有儿童均纳入研究。收集了人口统计学，临床，外科和放射学数据。

结果

发现有16名儿童在椎动脉的特定部位进行了解剖。十四名患者是男性。在激发性血管造影期间，发现有11个旋转受压。作为治疗的一部分，所有11例均接受了C1C2后融合术。他们的平均年龄为6.44岁（范围为18个月至15岁）。平均失血量为57.7 mL。发生了一个小的并发症：仅用口服抗生素治疗的浅表伤口感染。没有血管或神经系统损伤。诊断和/或治疗后无复发性缺血事件。平均随访时间为33.3个月（范围2–59个月）。我们设计了一种新的协议来管理儿童的V3解剖。

结论

后路C1C2融合术是治疗儿童椎动脉解剖动态压迫的安全有效选择。制定并遵守针对V3段解剖的严格诊断和治疗方案似乎可以预防中风复发。