{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T11:07:18Z","timestamp":1779361638535,"version":"3.51.4"},"reference-count":20,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"19","license":[{"start":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T00:00:00Z","timestamp":1778457600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurosurg Case Lessons"],"published-print":{"date-parts":[[2026,5,11]]},"abstract":"\n BACKGROUND<\/jats:title>\n Vertebral artery (VA) anomalies, particularly those associated with congenital atlantoaxial dislocations, are well documented in the literature. Typically, these anomalies are linked to persistent first intersegmental artery variants or occur in conjunction with occipitalization of the atlas. The case presented in this report is unique due to the presence of bilateral ectatic VAs with an anomalous course beneath the posterior arch of C1, in the absence of occipitalization of the atlas. This finding adds to the growing recognition of anatomical variability in patients with congenital conditions such as os odontoideum and Klippel-Feil syndrome (KFS).<\/jats:p>\n <\/jats:sec>\n \n OBSERVATIONS<\/jats:title>\n The authors present the case of a 65-year-old female patient with progressive cervical myelopathy, os odontoideum, and KFS. The preoperative imaging revealed the VA anomalies, and additional caution was exercised intraoperatively. The patient underwent C1\u20134 fixation and foramen magnum decompression using robot-assisted cervical fusion and neuronavigation.<\/jats:p>\n <\/jats:sec>\n \n LESSONS<\/jats:title>\n In patients with fused cervical segments, VA anomalies may be overlooked in preoperative imaging, highlighting the need for intraoperative vigilance. Robot-assisted surgery and neurophysiological monitoring significantly improve the safety and precision of the procedure, ensuring optimal outcomes in complex cases like this.<\/jats:p>\n \n https:\/\/thejns.org\/doi\/10.3171\/CASE25493<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/case25493","type":"journal-article","created":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T16:15:28Z","timestamp":1778516128000},"source":"Crossref","is-referenced-by-count":0,"title":["Robot- and navigation-assisted cervical fusion and decompression for complex vertebral artery anomalies in os odontoideum with Klippel-Feil syndrome: illustrative case"],"prefix":"10.3171","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4177-9615","authenticated-orcid":true,"given":"Asfand","family":"Baig Mirza","sequence":"first","affiliation":[{"name":"Neurosurgery Department, Queens Hospital, Romford"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Najla","family":"Mohammed","sequence":"additional","affiliation":[{"name":"Norfolk and Norwich University Healthcare Trust, Norwich"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Muath","family":"Abbakr","sequence":"additional","affiliation":[{"name":"Neurosurgery Department, Queens Hospital, Romford"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nadia","family":"El-Diaz","sequence":"additional","affiliation":[{"name":"West Middlesex University Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stuart","family":"Holder","sequence":"additional","affiliation":[{"name":"Neurosurgery Department, Queens Hospital, Romford"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Taofiq","family":"Desmond Sanusi","sequence":"additional","affiliation":[{"name":"Neurosurgery Department, Queens Hospital, Romford"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"3","key":"bib1","series-title":"J Ayub Med Coll Abbottabad","first-page":"573","article-title":"Surgical management of irreducible atlanto-axial dislocation with OS odontoideum and Klippel-Feil syndrome","volume":"34","author":"Akhtar","year":"2022","unstructured":"Akhtar MSRehman RUAli I.Surgical management of irreducible atlanto-axial dislocation with OS odontoideum and Klippel-Feil syndrome. J Ayub Med Coll Abbottabad. 2022;34(3):573-577. doi:10.55519\/jamc-03-9848"},{"issue":"22","key":"bib2","series-title":"Spine (Phila Pa 1976)","first-page":"E1389","article-title":"Anomalous vertebral arteries in the extra- and intraosseous regions of the craniovertebral junction visualized by 3-dimensional computed tomographic angiography: analysis of 100 consecutive surgical cases and review of the literature","volume":"37","author":"Yamazaki","year":"2012","unstructured":"Yamazaki MOkawa AFuruya TAnomalous vertebral arteries in the extra- and intraosseous regions of the craniovertebral junction visualized by 3-dimensional computed tomographic angiography: analysis of 100 consecutive surgical cases and review of the literature. Spine (Phila Pa 1976). 2012;37(22):E1389-E1397. doi:10.1097\/brs.0b013e31826a0c9f"},{"issue":"4","key":"bib3","series-title":"Korean J Radiol","first-page":"554","article-title":"A case of anomalous origin and course of vertebral artery in a patient with Klippel Feil syndrome","volume":"17","author":"Ulusoy","year":"2016","unstructured":"Ulusoy OLSasani HBarlas SBMutlu ASasani M.A case of anomalous origin and course of vertebral artery in a patient with Klippel Feil syndrome. Korean J Radiol. 2016;17(4):554-557. doi:10.3348\/kjr.2016.17.4.554"},{"issue":"1","key":"bib4","series-title":"J Neurosurg Spine","first-page":"5","article-title":"Operative nuances to safeguard anomalous vertebral artery without compromising the surgery for congenital atlantoaxial dislocation: untying a tough knot between vessel and bone","volume":"20","author":"Salunke","year":"2013","unstructured":"Salunke PFutane SSahoo SKGhuman MSKhandelwal N.Operative nuances to safeguard anomalous vertebral artery without compromising the surgery for congenital atlantoaxial dislocation: untying a tough knot between vessel and bone. 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