• Laxminadh Sivaraju, Sunithi Mani, Krishna Prabhu, Roy Thomas Daniel, and Ari George Chacko.
• Department of Neurological Sciences, Christian Medical College, Vellore, India. laxminadh.sivaraju@gmail.com.
• Eur Spine J. 2017 Apr 1; 26 (4): 1028-1038.

PurposeTo describe vertebral artery (VA) course at the C0-C1-C2 complex in patients with congenital bony craniovertebral junction (CVJ) anomalies.MethodsWe studied the course of 169 VAs in 86 patients with congenital bony CVJ anomalies [basilar invagination (42), os odontoideum (33), and irreducible atlantoaxial dislocation (11)]. Occipitalized atlas occurred in 41 patients (30 complete and 11 partial). Using axial, coronal and sagittal three-dimensional computed tomography (3D-CT) angiograms, we traced the VA bilaterally at the CVJ and correlated the course to the presence or absence of occipitalization of the atlas.ResultsOf the 73 arteries associated with occipitalization of atlas, all had an abnormal course-58 (78.4 %) coursed through a canal within the C0-C1 fused complex and 15 (20.3 %) coursed below the C1 posterior arch, and it was absent unilaterally in one patient. There were 96 arteries associated with a non-occipitalized atlas and only 15 (15.3 %) were abnormal-eight coursed below the C1 posterior arch, four coursed above the C1 arch in the absence of a C1 foramen transversarium, one passed through a canal in C0-C1 and two arteries were absent unilaterally. Sixty vertebral arteries (34 on the right and 26 on the left side) had a redundant loop situated at a distance of ≥5 mm from the C1 lateral mass in patients with os odontoideum and irreducible atlantoaxial dislocation.ConclusionsIn occipitalization of the atlas, the VA course is usually abnormal-typically passing through a canal within the C0-C1 fused complex or below the C1 arch. A redundant VA loop is more likely to be seen in os odontoideum and irreducible atlantoaxial dislocation. Careful study of the vertebral artery course with 3D CT angiography is mandatory while contemplating CVJ realignment surgery in congenital anomalies of the CVJ.

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