An anatomical exploration of the extracranial (V1-V3) and intracranial (V4) components of the vertebral arteries in a select KwaZulu-Natal population.
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Date
2021
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Abstract
The risk of injury to the vertebral artery is a significant complication of surgery. The presence of
anatomical variation in the course of the vertebral artery increases the likelihood of injury. Due to
inadequate understanding of the presence and location of anatomical variations in the morphology and
morphometry, the vertebral artery can be injured during surgical intervention. Apart from the vascular
injury that can occur during surgical intervention, anatomical variations have implications for some
pathologies in the posterior circulation territory. These include aneurysm formation, cerebrovascular
disorders, posterior circulatory stroke, and some neurovascular problems. In this retrospective
observational study, we investigated the anatomical features of the extracranial (V1-V3) and
intracranial (V4) components of the vertebral arteries in a South African population. The study is an
observational, retrospective chart review of 554 consecutive South African patients (Black, Indian, and
White) who had undergone computed tomography angiography (CTA) at Lenmed Ethekwini Hospital
and Heart Centre, Durban, South Africa, from January 2009 to September 2019. The vertebral artery
exhibited various morphological variations in its course. We report the incidence of variant origin of
the left vertebral artery (6.9%). The level of entry into the transverse foramen ranged between C7-C3.
We report the incidence of vertebral artery tortuosity at V1, V2: 76.6%, and 32.1%, respectively. We
observed fenestration at V3 (0.18%) and V4 (0.4%) segments. We registered the incidence of the
persistent first intersegmental artery (1.1%), extradural PICA origin (2.8%), atresia (6.7%), and
hypoplastic terminal vertebral artery (13.2%). Average length and diameter at each vertebral artery
segment were registered; we also report on hypoplasia of the vertebral artery. Anatomical variations of
the vertebral artery are common in the South African population studied in the present study. Imaging
of the complete segments of the vertebral artery from the origin to the point of convergence to form the
basilar artery may be necessary to decide a treatment strategy for interventions in the vicinity of the
vertebral artery. Understanding the patterns of anatomical variations of the vertebral arteries will
contribute significantly to the diagnosis of various diseases in the posterior circulatory territory. The
average diameter was significantly larger on the left in all the racial groups, but there were no significant
gender differences. We registered a left dominance pattern in all the segments (V1-V4).
Iqoqa
Ingozi yokulimala emithanjeni yomgogodla iyinkinga enzima kakhulu yokuhlinzwa. Ukuba khona
kokwehlukahlukana kokwakheka komzimba ekuhambeni komthambo womgogodla kwandisa
amathuba okulimala. Ngenxa yokuqonda okunganele kokukhona kanye nendawo yokwehlukahlukana
kwesakhikwo somzimba ekwakhekeni nokulinganisa umumo, umthambo womgogodla ungalimala
ngesikhathi sokuhlinzwa. Ngaphandle kokulimala kwemithambo yegazi okungenzeka ngesikhathi
sokuhlinzwa, ukuhlukahlukana kwemithamdo yomgogodla kunomthelela ngezinye izimbangela
ngokuthola umsuka wesifo ngokuhamba kwegazi emigudwini. Lokhu kubandakanya ukwakheka
kokuvuvukala komthambo, ukuphazamiseka kokuhamba kwegazi engqondweni, ukushaywa yisifo
sohlangothi, nezinye izinkinga ngezinzwa nemithambo. Kulolu cwaningo lokubheka ngokuqhathanisa
abanesifo nabangenaso, sibheke ukwakheka komzimba kwamathambo ekhanda ngaphandle (V1-V3)
kanye nokwakheka kwawo ngaphakathi (V4) nezingxenye zemithambo yomgogodla emphakathini
waseNingizimu Afrikha. Ucwaningo lungukuzibonela ngqo, ukuqhathanisa ngokubuyekeza amashadi
eziguli zaseNingizimu Afrikha angama-554 ngokulandelana (abaNsundu, amaNdiya, nabaMhlophe)
abafakwe emshinini bahlolwa wonke umzimba ngekhompuyutha ukubona okusemithanjeni
(isibonathambomzimba) (CTA) esibhedlela i-Lenmed Ethekwini neSikhungo seNhliziyo, eThekwini,
eNingizimu Afrikha, kusukela kuMasingana wowezi-2009 kuya kuMandulo wowezi-2019. Umthambo
womgogodla ukhombisa ukwehlukahluka kwesakhiwo ekuthubelezeni kwawo. Sibika isehlakalo
semvelaphi esehlukile somthambo womgogodla kwesokunxele (6.9%). Izinga lokungena esikhaleni
esiphakathi komthambo womgogodla laliphakathi kwe-C7 ne-C3. Sibika isehlakalo esihambisana
nokuguga komthambo womgogodla nomfutho wegazi okulinganiselwa phakathi kuka-V1, V2: 76.6%
no-32.1%, ngokulandelana. Sibone ukuhlinzwa kwesakhiwo sendlebe ngaphakathi kwezingxenye
ezingu-V3 (0.18%) nezingu-V4 (0.4%). Sabhalisa izehlakalo zomthambo wokuqala ngezingxenye
ezilokhu zikhona ngo-1.1%, imvelaphi ye-PICA yamathambo ekhanda (2.8%), isicubu esingenayo
embotsheni ngokwemvelo (6.7%), nokungakhuli kwesitho ngokuphelele (13.2%). Isilinganiso sobude
nobubanzi engxenyeni ngayinye yomthambo womgogodla yabhaliswa; siphinde sibike
ngokungasebenzi ngokwejwayelekile komthambo womgogoda. Ukwehlukahlukana kokwakheka
komthambo womgogodla kuvamile kubantu baseNingizimu Afrikha ocwaningweni lwamanje.
Ukufanekisa kwezingxenye eziphelele zomthambo womgogodla lapho zihlangana khona ukwenza
umthambo ophakathi nendawo ekhanda kungadingakala ukunquma ngamasu okwelapha
ngokungenelela endaweni eseduze nomthambo womgogodla. Ukuqonda ukuphiceka kwesakhiwo
esahlukahlukene semithambo yomgogodla kuzodlala indima ebalulekile ekuhlonzeni izifo
ezahlukahlukene ekuhlinzekweni kokuhamba kwegazi. Isilinganiso sobubanzi besisikhulu kakhulu
kwesokunxele kuwo wonke amaqembu ezinhlanga, kodwa kwakungekho mehluko obalulekile phakathi
kobulili. Sibhalise indlelakwenza ebihamba phambili kuzo zonke izingxenye ebe ngu-V1-V4.
Description
Doctoral Degree. University of KwaZulu-Natal, Durban.