Vol.100 No.12 contentsPRACTICA OTO-RHINO-LARYNGOLOGICA
Vol. 100 No. 12 December 2007
Vertebral Artery Dissection after Direct Laryngoscopy
Kuniyuki Takahashi, Yutaka Yamamoto and Sugata Takahashi
(Niigata University, School of Medicine)
Yoshio Sekihara
(Mitsuke Municipal Hospital)
Hiroshi Abe
(Tachikawa General Hospital)
A case of subarachnoid hemorrhage due to vertebral artery dissection after direct laryngoscopy is reported. The patient, a healthy 61-year-old man with hoarseness, was treated for vocal cord polyp with laryngomicrosurgery. After surgery, he complained of nape pain without neurological symptoms. Six days after the onset of nape pain, he suddenly lost consciousness. CT showed subarachnoid hemorrhage and CT angiography demonstrated enlargement of the right vertebral artery which was suspected to be dissecting aneurysm. The right vertebral artery was occluded proximal to the aneurysmal dilation using detachable coils. Most vertebral artery dissections have been described as showing spontaneous onset. Recently, some cases were associated with minor neck trauma like extension and/or rotation. Direct laryngoscopy is a widely used technique in otolaryngological surgery, but it requires that the patient's neck be placed in hyperextension. This is the first report of vertebral artery dissection as a complication of otolaryngological surgery. Physicians should recognize that a hyperextended neck position during surgery may induce vertebral artery injury.
Key words :vertebral artery dissection, direct laryngoscopy, neck hyperextension