case_images: PMC8053469_01
case_images: : Preoperative CTa sagittal (a and c) reconstructions demonstrate the changes associated with diffuse idiopathic skeletal hyperostosis and the "fang"-like elongation of the C5 lateral mass (black circle) with mass effect on the vertebral artery. Axial (b and d) reconstructions demonstrate ventral osteophytes (white arrow) which displace the esophagus (white arrowheads) and display the osseous growth (black arrow). A 3D reconstruction (e) further details the precise anatomical location of the stenosis at C4-5.
case_images: SNI-12-104-g001.jpg
case_images: PMC8053469_01_SNI-12-104-g001.jpg
case_images: F1
case_images: A CT angiogram (CTa) of the head and neck demonstrated osseous changes consistent with cervical DISH as well as a "fang"-like osseous elongation of the right C5 lateral mass, which protruded into the vertebral foramen and compressed the VA [Figure 1].
case_images: AP (a) and lateral (b) cervical right vertebral artery (VA) digital subtraction angiography demonstrates the compression in neutral (white arrow) and occlusion with head rotation (c and d). AP (e) and lateral (f) left VA angiography demonstrates the artery ends in the left posterior inferior cerebellar artery and does not join the right VA.
case_images: SNI-12-104-g002.jpg
case_images: PMC8053469_01_SNI-12-104-g002.jpg
case_images: F2
case_images: A catheter-based cranial and cervical digital subtraction angiogram (DSA) demonstrated approximately 74% stenosis of the right VA at C5 in the neutral position, which progressed to full occlusion with right head rotation [Figure 2].
case_images: A postoperative CTa sagittal (a) and axial (b) reconstructions demonstrate osseous remodeling of the "fang"-like elongation with blunting of the growth (black circle and black arrow). A postoperative digital subtraction angiography (c and d) 9 months after surgery demonstrates resolution of the compression in neutral and with head rotation.
case_images: SNI-12-104-g003.jpg
case_images: PMC8053469_01_SNI-12-104-g003.jpg
case_images: F3
case_images: The CTa demonstrated blunting of the osseous growth at C5, and the DSA showed no evidence of VA compression in the neutral or dynamic positions [Figure 3].