Surgical treatment of patients with symptomatic Kimmerle anomaly using video endoscopy

Abstract

Background: Clinical manifestations of Kimmerle anomaly (AK) are detected in 5.5 to 20% of patients. The main reason for the development of symptoms is prolonged compression of the V3 (atlantic) segment of the vertebral artery (VA) in the bone ring formed as a result of exostosis of the atlantooccipital membrane. To date, the final tactics of treating patients with AK has not been determined. The effectiveness of conservative methods of therapy does not exceed 40%. The aim of the study was to evaluate the result of minimally invasive surgical treatment of patients with symptomatic AK using video endoscopic assistance. Methods: In the period from 2020 to 2022, 15 patients were operated on. The indication for surgical treatment was the lack of effect of conservative therapy for 1 year after the onset of the disease, the increase in the symptoms of the disease, the decrease in blood flow through the vertebral artery from the side of the AC when turning the head. In two (13%) patients, VA decompression was performed through a posterior median approach, and in thirteen (87%) patients, through a paravertebral intermuscular approach (4 cm incision in the occipitocervical region in the projection of the AC) using video endoscopy.Results: The outcome of the disease was assessed at discharge from the hospital, as well as 6 and 12 months after the operation. After surgical treatment, all patients showed complete regression of symptoms, restoration of blood flow velocities in VA. There were no complications after the operation. The use of video endoscopy made it possible to reduce the size of the surgical wound from 12 cm to 4 cm, which contributed to a decrease in the intensity of pain in the postoperative period, early activation and a decrease in the duration of inpatient treatment.Conclusion: With proper selection of patients with AV, decompression of the V3 segment of the VA using video endoscopy is a safe and effective method of treatment.