open access

Vol 82, No 3 (2023)
Case report
Submitted: 2022-03-29
Accepted: 2022-05-04
Published online: 2022-06-10
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Bilateral vertebral arteries entering the C4 foramen transversarium with the left vertebral artery originating from the aortic arch

C. J. Dean1, K. Labagnara1, A. K. Lee1, D. J. Yun1, Z. Dong1, P. L. Mishall12, A. Pinkas1
·
Pubmed: 35692111
·
Folia Morphol 2023;82(3):721-725.
Affiliations
  1. Department of Pathology, Albert Einstein College of Medicine, Bronx, NY, United States
  2. Department of Ophthalmology and Visual Science, Albert Einstein College of Medicine, Bronx, NY, United States

open access

Vol 82, No 3 (2023)
CASE REPORTS
Submitted: 2022-03-29
Accepted: 2022-05-04
Published online: 2022-06-10

Abstract

Vertebral arteries (VAs) serve as major blood vessels to the central nervous system.
VAs typically arise from the subclavian arteries and ascend separately within the
transverse foramina of the cervical vertebrae (C6-C1) before entering the skull at
the foramen magnum and joining at the base of the pons to form the basilar artery
of the vertebrobasilar circulation. Therefore, variations in the origin and anatomic
course of the VAs have implications for invasive medical procedures involving
the superior thoracic/cervical regions or the cervical vertebrae. The current case
report describes variation in the entry point of both VAs and the site of origin of
the left vertebral artery. The variation was revealed during routine dissection of
a 72-year-old female cadaver. It was found that the left vertebral artery originated
directly from the aortic arch to abnormally enter the transverse foramen of C4
instead of the transverse foramen of C6. The right vertebral artery arose as usual
from the right subclavian artery. However, the right vertebral artery also directly
entered the transverse foramen of C4 instead of the transverse foramen of C6.

Abstract

Vertebral arteries (VAs) serve as major blood vessels to the central nervous system.
VAs typically arise from the subclavian arteries and ascend separately within the
transverse foramina of the cervical vertebrae (C6-C1) before entering the skull at
the foramen magnum and joining at the base of the pons to form the basilar artery
of the vertebrobasilar circulation. Therefore, variations in the origin and anatomic
course of the VAs have implications for invasive medical procedures involving
the superior thoracic/cervical regions or the cervical vertebrae. The current case
report describes variation in the entry point of both VAs and the site of origin of
the left vertebral artery. The variation was revealed during routine dissection of
a 72-year-old female cadaver. It was found that the left vertebral artery originated
directly from the aortic arch to abnormally enter the transverse foramen of C4
instead of the transverse foramen of C6. The right vertebral artery arose as usual
from the right subclavian artery. However, the right vertebral artery also directly
entered the transverse foramen of C4 instead of the transverse foramen of C6.

Get Citation

Keywords

vertebral artery, aortic arch, cervical vertebrae, transverse foramen

About this article
Title

Bilateral vertebral arteries entering the C4 foramen transversarium with the left vertebral artery originating from the aortic arch

Journal

Folia Morphologica

Issue

Vol 82, No 3 (2023)

Article type

Case report

Pages

721-725

Published online

2022-06-10

Page views

1081

Article views/downloads

705

DOI

10.5603/FM.a2022.0059

Pubmed

35692111

Bibliographic record

Folia Morphol 2023;82(3):721-725.

Keywords

vertebral artery
aortic arch
cervical vertebrae
transverse foramen

Authors

C. J. Dean
K. Labagnara
A. K. Lee
D. J. Yun
Z. Dong
P. L. Mishall
A. Pinkas

References (12)
  1. Bruneau M, Cornelius JF, Marneffe V, et al. Anatomical variations of the V2 segment of the vertebral artery. Neurosurgery. 2006; 59(1 Suppl 1): ONS20–4; discussion ONS20.
  2. Detton AJ. Grant's Dissector. 17th ed. Wolters Kluwer Health/Lippincott Williams & Wilkins, Philadelphia, PA 2020.
  3. Einstein EH, Song LH, Villela NLA, et al. Anomalous origin of the left vertebral artery from the aortic arch. Aorta (Stamford). 2016; 4(2): 64–67.
  4. Eskander MS, Drew JM, Aubin ME, et al. Vertebral artery anatomy: a review of two hundred fifty magnetic resonance imaging scans. Spine (Phila Pa 1976). 2010; 35(23): 2035–2040.
  5. Gitkind AI, Olson TR, Downie SA. Vertebral artery anatomical variations as they relate to cervical transforaminal epidural steroid injections. Pain Med. 2014; 15(7): 1109–1114.
  6. Goray VB, Joshi AR, Garg A, et al. Aortic arch variation: a unique case with anomalous origin of both vertebral arteries as additional branches of the aortic arch distal to left subclavian artery. AJNR Am J Neuroradiol. 2005; 26(1): 93–95.
  7. Hong JT, Park DK, Lee MJ, et al. Anatomical variations of the vertebral artery segment in the lower cervical spine: analysis by three-dimensional computed tomography angiography. Spine (Phila Pa 1976). 2008; 33(22): 2422–2426.
  8. Satti SR, Cerniglia CA, Koenigsberg RA. Cervical vertebral artery variations: an anatomic study. AJNR Am J Neuroradiol. 2007; 28(5): 976–980.
  9. Shin HY, Park JiK, Park SK, et al. Variations in entrance of vertebral artery in Korean cervical spine: MDCT-based analysis. Korean J Pain. 2014; 27(3): 266–270.
  10. Siedlecki Z, Szostak M, Nowak K, et al. Atypical course of vertebral artery outside the cervical spine: case report and review of the literature. World Neurosurg. 2021; 145: 405–408.
  11. Yuan SM. Aberrant origin of vertebral artery and its clinical implications. Braz J Cardiovasc Surg. 2016; 31(1): 52–59.
  12. Zhang M, Dayani F, Purger DA, et al. Extraforaminal vertebral artery anomalies and their associated surgical implications: an epidemiologic and anatomic report on 1000 patients. World Neurosurg. 2020; 141: e971–e975.

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