Fatal vertebral artery pseudoaneurysm following intracranial migration of an odontoid screw: illustrative case.

Mohsen Rostami, Phillip M Johansen, Elliot Pressman, Gersham Rainone, Anjali Pradhan, Natalie Bales, Srujan Kopparapu, Puya Alikhani
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Abstract

Background: Intracranial migration of odontoid screws is an exceedingly rare complication following anterior odontoid fixation. When such migration involves vital neurovascular structures, the consequences can be catastrophic. Although anterior odontoid screw fixation (AOSF) is generally well tolerated and biomechanically favorable, hardware failure leading to vertebral artery (VA) injury is sparsely reported.

Observations: The authors present the case of a 79-year-old man who previously underwent AOSF for a type II odontoid fracture. He presented with acute neck pain after lifting a heavy object and was found to have cranial migration of the odontoid screw into the foramen magnum, causing mass effect on the right VA and a premedullary subarachnoid hemorrhage. After multidisciplinary evaluation, the patient underwent successful removal of the screw with anterior cervical exposure, followed by intraoperative detection and embolization of a right V4 segment VA pseudoaneurysm using overlapping flow diverter stents. Despite initial neurological stability, he developed respiratory decline and sepsis and ultimately died of multiorgan failure.

Lessons: This case highlights the importance of long-term surveillance following spinal instrumentation, the value of multidisciplinary coordination in managing complex neurovascular complications, and the fact that procedural success does not always guarantee favorable clinical outcomes in older, comorbid patients. https://thejns.org/doi/10.3171/CASE25538.

齿状突螺钉颅内移位后致死性椎动脉假性动脉瘤:说明性病例。
背景:齿状突螺钉颅内移位是齿状突前路固定后极为罕见的并发症。当这种迁移涉及到重要的神经血管结构时,后果可能是灾难性的。虽然前牙状突螺钉固定(AOSF)通常耐受性良好且生物力学有利,但导致椎动脉(VA)损伤的硬体失效鲜有报道。观察:作者提出了一例79岁的男性,他之前因II型齿状突骨折接受了AOSF。患者在举起重物后出现急性颈部疼痛,发现齿状突螺钉颅骨移位至枕骨大孔,导致右侧VA肿块效应和髓前蛛网膜下腔出血。经多学科评估,患者成功取出颈椎前路暴露螺钉,术中使用重叠分流支架检测并栓塞右V4段VA假性动脉瘤。尽管最初神经系统稳定,但他出现了呼吸衰退和败血症,最终死于多器官衰竭。经验教训:本病例强调了脊柱内固定后长期监测的重要性,多学科协调在处理复杂神经血管并发症中的价值,以及手术成功并不总是保证老年合并症患者的良好临床结果。https://thejns.org/doi/10.3171/CASE25538。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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