Evaluation of the groove for vertebral artery using CT angiography

Year 2017, Volume: 11 Issue: 2, 61 - 66, 20.08.2017

Ayşegül Fırat , Nurhan Erbil Rahşan Göçmen

Abstract

Objectives: Groove for vertebral artery (sulcus arteriae vertebralis) is located on the posterior arch of the first cervical vertebra (atlas) where the vertebral artery passes over to reach the foramen magnum. The bony process between the posterior arch and the superior articulating process of the atlas is a common variation usually detected by lateral radiographies. This bony bridge is most commonly named as the ponticulus posticus. The aim of this study was to evaluate the existence of the ponticulus posticus and morphological features of the groove for vertebral artery.

Methods: We performed a retrospective analysis of the groove for vertebral artery from 347 head and neck CT angiographies (694 bilaterally) at the Department of Radiology, Hacettepe University School of Medicine.

Results: Complete ponticulus posticus incidence was found to be 12.1%, and 27.38% of these were bilateral. Post-sulcus arterial dimensions were found to be narrower than the pre-sulcus dimensions of the vertebral artery if the ponticulus posticus was incomplete.

Conclusion: The groove for vertebral artery is a commonly studied variation among different nations and using different methods like lateral dental graphies, cadaveric studies and dry skulls. This study will be a guide for clinical problems like headache, vascular diseases and surgical interventions of the atlas in a very large patient population and using CT angiography, a sensitive method for visualizing this area.

Keywords

arcuate foramen, CT angiography, groove for vertebral artery, ponticulus posticus

References

• 1. Ahmad FU, Wang MY. Lateral mass of C1 fixation and ponticulusposticus. World Neurosurg 2014;82:E145–6.
• 2. Bayrakdar IS, Miloglu O, Altun O, Gumussoy I, Durna D, Yilmaz AB. Cone beam computed tomography imaging of ponticulus posticus: prevalence, characteristics, and a review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol 2014;118:E210–9.
• 3. Cakmak G, Gurdal E, Ekinci G, Yildiz E, Cavdar S. Arcuate foramen and its clinical significance. Saudi Med J 2005;26:1409–13.
• 4. Chen CH, Chen YK, Wang CK. Prevalence of ponticuli posticus among patients referred for dental examinations by cone-beam CT. Spine J 2015;15:1270–6.
• 5. Cushing KE, Ramesh V, Gardner-Medwin D, Todd NV, Gholkar A, Baxter P, Griffiths PD. Tethering of the vertebral artery in the congenital arcuate foramen of the atlas vertebra: a possible cause of vertebral artery dissection in children. Dev Med Child Neurol 2001;43:491–6.
• 6. Dhall U, Chhabra S, Dhall JC. Bilateral asymmetry in bridges and superior articular facets of atlas vertebra. J Anat Soc India 1993;42: 23–7.
• 7. Elliott RE, Tanweer O. The prevalence of the ponticulus posticus (arcuate foramen) and its importance in the goel-harms procedure: meta-analysis and review of the literature. World Neurosurg 2014;82:E335–43.
• 8. Hasan M, Shukla S, Siddiqui MS, Singh D. Posterolateral tunnels and ponticuli in human atlas vertebrae. J Anat 2001;199:339–43.
• 9. Kavakli A, Aydinlioglu A, Yesilyurt H, Kus I, Diyarbakirli S, Erdem S, Anlar O. Variants and deformities of atlas vertebrae in Eastern Anatolian people. Saudi Med J 2004;25:322–5.
• 10. Kendrick GS, Biggs NL. Incidence of ponticulus posticus of first cervical vertebra between ages 6 to 17. Anat Rec 1963;145:449–53.
• 11. Kim MS. Anatomical variant of atlas: arcuate foramen, occipitalization of atlas, and defect of posterior arch of atlas. J Korean Neurosurg Soc 2015;8:528–33.
• 12. Split W, Sawrasewicz-Rybak M. Character of headache in Kimmerle anomaly. Headache 2002;42:911–6.
• 13. Wight S, Osborne N, Breen AC. Incidence of ponticulus posterior of the atlas in migraine and cervicogenic headache. J Manipulative Physiol Ther 1999;22:15–20.
• 14. Lamberty BG, Zivanovic S. The retro-articular vertebral artery ring of the atlas and its significance. Acta Anat 1973;85:113–22.
• 15. Paraskevas G, Papaziogas B, Tsonidis C, Kapetanos G. Gross morphology of the bridges over the vertebral artery groove on the atlas. Surg Radiol Anat 2005;27:129–36.
• 16. Sekerci AE, Soylu E, Arikan MP, Ozcan G, Amuk M, Kocoglu F. Prevalence and morphologic characteristics of ponticulus posticus: analysis using cone-beam computed tomography. J Chiropr Med 2015;14:153–61.
• 17. Sharma V, Chaudhary D, Mitra R. Prevalence of ponticulus posticus in Indian orthodontic patients. Dentomaxillofac Radiol 2010;39:277–83.
• 18. Vernon H. Cervicogenic headache. In: Gatterman MI, editor. Foundations of the chiropractic subluxation. St Louis (MO): Mosby 1995;306–16.
• 19. Young JP, Young PH, Ackermann MJ, Anderson PA, Riew KD. The ponticulus posticus: implications for screw insertion into the first cervical lateral mass. J Bone Joint Surg Am 2005;87:2495–98.
• 20. Simsek S, Yigitkanli K, Comert A, Acar HI, Seckin H, Er U, Belen D, Tekdemir I, Elhan A. Posterior osseous bridging of C1. J Clin Neurosci 2008;15:686–8.
• 21. Tubbs RS, Johnson PC, Shoja MM, Loukas M, Oakes WJ. Foramen arcuale: anatomical study and review of the literature. J Neurosurg Spine 2007;6:31–4.
• 22. Kim KH, Park KW, Manh TH, Yeom JS, Chang BS, Lee CK. Prevalence and morphologic features of ponticulus posticus in Koreans: analysis of 312 radiographs and 225 three-dimensional CT scans. Asian Spine J 2007;1:27–31.