{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T23:18:54Z","timestamp":1769728734043,"version":"3.49.0"},"reference-count":24,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"13","license":[{"start":{"date-parts":[[2025,9,29]],"date-time":"2025-09-29T00:00:00Z","timestamp":1759104000000},"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":[[2025,9,29]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Intracranial migration of odontoid screws is an exceedingly rare complication following anterior odontoid fixation. When such migration involves vital neurovascular structures, the consequences can be catastrophic. Although anterior odontoid screw fixation (AOSF) is generally well tolerated and biomechanically favorable, hardware failure leading to vertebral artery (VA) injury is sparsely reported.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>The authors present the case of a 79-year-old man who previously underwent AOSF for a type II odontoid fracture. He presented with acute neck pain after lifting a heavy object and was found to have cranial migration of the odontoid screw into the foramen magnum, causing mass effect on the right VA and a premedullary subarachnoid hemorrhage. After multidisciplinary evaluation, the patient underwent successful removal of the screw with anterior cervical exposure, followed by intraoperative detection and embolization of a right V4 segment VA pseudoaneurysm using overlapping flow diverter stents. Despite initial neurological stability, he developed respiratory decline and sepsis and ultimately died of multiorgan failure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>This case highlights the importance of long-term surveillance following spinal instrumentation, the value of multidisciplinary coordination in managing complex neurovascular complications, and the fact that procedural success does not always guarantee favorable clinical outcomes in older, comorbid patients.<\/jats:p>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/thejns.org\/doi\/10.3171\/CASE25538\">https:\/\/thejns.org\/doi\/10.3171\/CASE25538<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case25538","type":"journal-article","created":{"date-parts":[[2025,10,7]],"date-time":"2025-10-07T00:02:18Z","timestamp":1759795338000},"source":"Crossref","is-referenced-by-count":0,"title":["Fatal vertebral artery pseudoaneurysm following intracranial migration of an odontoid screw: illustrative case"],"prefix":"10.3171","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1296-9751","authenticated-orcid":true,"given":"Mohsen","family":"Rostami","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Brain and Spine, Morsani College of Medicine, University of South Florida, Tampa, Florida"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Phillip M.","family":"Johansen","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Brain and Spine, Morsani College of Medicine, University of South Florida, Tampa, Florida"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5160-802X","authenticated-orcid":true,"given":"Elliot","family":"Pressman","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Brain and Spine, Morsani College of Medicine, University of South Florida, Tampa, Florida"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5365-3334","authenticated-orcid":true,"given":"Gersham","family":"Rainone","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Brain and Spine, Morsani College of Medicine, University of South Florida, Tampa, Florida"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anjali","family":"Pradhan","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Brain and Spine, Morsani College of Medicine, University of South Florida, Tampa, Florida"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-2328-7873","authenticated-orcid":true,"given":"Natalie","family":"Bales","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Brain and Spine, Morsani College of Medicine, University of South Florida, Tampa, Florida"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Srujan","family":"Kopparapu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Brain and Spine, Morsani College of Medicine, University of South Florida, Tampa, Florida"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Puya","family":"Alikhani","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Brain and Spine, Morsani College of Medicine, University of South Florida, Tampa, Florida"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"bib1","series-title":"Scand J Trauma Resusc Emerg Med","first-page":"85","article-title":"The epidemiology of traumatic cervical spine fractures: a prospective population study from Norway","volume":"20","author":"Fred\u00f8","year":"2012","unstructured":"Fred\u00f8 HLRizvi SAMLied BR\u00f8nning PHelseth E.The epidemiology of traumatic cervical spine fractures: a prospective population study from Norway. Scand J Trauma Resusc Emerg Med. 2012;20:85."},{"issue":"20","key":"bib2","series-title":"J Clin Med","first-page":"6270","article-title":"Odontoid fractures: a review of the current state of the art","volume":"13","author":"Nouri","year":"2024","unstructured":"Nouri ADa Broi MMay AOdontoid fractures: a review of the current state of the art. J Clin Med. 2024;13(20):6270."},{"key":"bib3","series-title":"Brain Spine","first-page":"104205","article-title":"The management of odontoid fractures through the lens of evolution in classification schemes: a systematic review with illustrative case examples","volume":"5","author":"Dantas","year":"2025","unstructured":"Dantas FLRDantas FPedro KMda Fonseca VKTFehlings MG.The management of odontoid fractures through the lens of evolution in classification schemes: a systematic review with illustrative case examples. Brain Spine. 2025;5:104205."},{"issue":"1","key":"bib4","series-title":"Glob Spine J","first-page":"47","article-title":"Short-term complications of anterior fixation of odontoid fractures","volume":"8","author":"Cutler","year":"2018","unstructured":"Cutler HSGuzman JZLee NJShort-term complications of anterior fixation of odontoid fractures. Glob Spine J. 2018;8(1):47-56."},{"issue":"4","key":"bib5","series-title":"Neurosurg Focus","first-page":"E7","article-title":"Avoiding pitfalls in anterior screw fixation for type II odontoid fractures","volume":"31","author":"Mazur","year":"2011","unstructured":"Mazur MDMumert MLBisson EFSchmidt MH.Avoiding pitfalls in anterior screw fixation for type II odontoid fractures. Neurosurg Focus. 2011;31(4):E7."},{"key":"bib6","series-title":"World Neurosurg","first-page":"e279","article-title":"Anterior odontoid screw fixation for C2 fractures: surgical nuances, complications, and factors affecting fracture union","volume":"152","author":"Tyagi","year":"2021","unstructured":"Tyagi GPatel KRSingh GJAnterior odontoid screw fixation for C2 fractures: surgical nuances, complications, and factors affecting fracture union. World Neurosurg. 2021;152:e279-e288."},{"issue":"5","key":"bib7","series-title":"Spine J","first-page":"e309","article-title":"Progressive quadriparesis caused by anterior odontoid screw upward migration in rheumatoid arthritis","volume":"16","author":"Simonin","year":"2016","unstructured":"Simonin ABorsotti FChittur-Viswanathan GDuff JM.Progressive quadriparesis caused by anterior odontoid screw upward migration in rheumatoid arthritis. Spine J. 2016;16(5):e309-e310."},{"key":"bib8","series-title":"Surg Neurol Int","first-page":"173","article-title":"Postoperative intracranial migration of a C2 odontoid screw: a case report and literature review","volume":"10","author":"Chandra","year":"2019","unstructured":"Chandra AMoon SJWalker BYilmaz EMoisi MJohnson R.Postoperative intracranial migration of a C2 odontoid screw: a case report and literature review. Surg Neurol Int. 2019;10:173."},{"issue":"6","key":"bib9","series-title":"J Neurosurg Spine","first-page":"715","article-title":"Delayed subarachnoid hemorrhage following failed odontoid screw fixation","volume":"14","author":"Wilson","year":"2011","unstructured":"Wilson DAFusco DJTheodore N.Delayed subarachnoid hemorrhage following failed odontoid screw fixation. J Neurosurg Spine. 2011;14(6):715-718."},{"issue":"3","key":"bib10","series-title":"Korean J Spine","first-page":"289","article-title":"Delayed pharyngeal extrusion of an anterior odontoid screw","volume":"9","author":"Lee","year":"2012","unstructured":"Lee EJJang JWChoi SHRhim SC.Delayed pharyngeal extrusion of an anterior odontoid screw. Korean J Spine. 2012;9(3):289-292."},{"key":"bib11","series-title":"Case Rep Med","first-page":"2923696","article-title":"Passage of an anterior odontoid screw through gastrointestinal tract","volume":"2017","author":"Leitner","year":"2017","unstructured":"Leitner LBr\u00fcckmann CIGilg MMPassage of an anterior odontoid screw through gastrointestinal tract. Case Rep Med. 2017;2017:2923696."},{"issue":"suppl 1","key":"bib12","series-title":"Neurosurgery","first-page":"S47","article-title":"Antiplatelet therapy in flow diversion","volume":"86","author":"Tonetti","year":"2020","unstructured":"Tonetti DAJankowitz BTGross BA.Antiplatelet therapy in flow diversion. Neurosurgery. 2020;86(suppl 1):S47-S52."},{"key":"bib1","series-title":"Scand J Trauma Resusc Emerg Med","first-page":"85","article-title":"The epidemiology of traumatic cervical spine fractures: a prospective population study from Norway","volume":"20","author":"Fred\u00f8","year":"2012","unstructured":"Fred\u00f8 HLRizvi SAMLied BR\u00f8nning PHelseth E.The epidemiology of traumatic cervical spine fractures: a prospective population study from Norway. Scand J Trauma Resusc Emerg Med. 2012;20:85."},{"issue":"20","key":"bib2","series-title":"J Clin Med","first-page":"6270","article-title":"Odontoid fractures: a review of the current state of the art","volume":"13","author":"Nouri","year":"2024","unstructured":"Nouri ADa Broi MMay AOdontoid fractures: a review of the current state of the art. J Clin Med. 2024;13(20):6270."},{"key":"bib3","series-title":"Brain Spine","first-page":"104205","article-title":"The management of odontoid fractures through the lens of evolution in classification schemes: a systematic review with illustrative case examples","volume":"5","author":"Dantas","year":"2025","unstructured":"Dantas FLRDantas FPedro KMda Fonseca VKTFehlings MG.The management of odontoid fractures through the lens of evolution in classification schemes: a systematic review with illustrative case examples. Brain Spine. 2025;5:104205."},{"issue":"1","key":"bib4","series-title":"Glob Spine J","first-page":"47","article-title":"Short-term complications of anterior fixation of odontoid fractures","volume":"8","author":"Cutler","year":"2018","unstructured":"Cutler HSGuzman JZLee NJShort-term complications of anterior fixation of odontoid fractures. Glob Spine J. 2018;8(1):47-56."},{"issue":"4","key":"bib5","series-title":"Neurosurg Focus","first-page":"E7","article-title":"Avoiding pitfalls in anterior screw fixation for type II odontoid fractures","volume":"31","author":"Mazur","year":"2011","unstructured":"Mazur MDMumert MLBisson EFSchmidt MH.Avoiding pitfalls in anterior screw fixation for type II odontoid fractures. Neurosurg Focus. 2011;31(4):E7."},{"key":"bib6","series-title":"World Neurosurg","first-page":"e279","article-title":"Anterior odontoid screw fixation for C2 fractures: surgical nuances, complications, and factors affecting fracture union","volume":"152","author":"Tyagi","year":"2021","unstructured":"Tyagi GPatel KRSingh GJAnterior odontoid screw fixation for C2 fractures: surgical nuances, complications, and factors affecting fracture union. World Neurosurg. 2021;152:e279-e288."},{"issue":"5","key":"bib7","series-title":"Spine J","first-page":"e309","article-title":"Progressive quadriparesis caused by anterior odontoid screw upward migration in rheumatoid arthritis","volume":"16","author":"Simonin","year":"2016","unstructured":"Simonin ABorsotti FChittur-Viswanathan GDuff JM.Progressive quadriparesis caused by anterior odontoid screw upward migration in rheumatoid arthritis. Spine J. 2016;16(5):e309-e310."},{"key":"bib8","series-title":"Surg Neurol Int","first-page":"173","article-title":"Postoperative intracranial migration of a C2 odontoid screw: a case report and literature review","volume":"10","author":"Chandra","year":"2019","unstructured":"Chandra AMoon SJWalker BYilmaz EMoisi MJohnson R.Postoperative intracranial migration of a C2 odontoid screw: a case report and literature review. Surg Neurol Int. 2019;10:173."},{"issue":"6","key":"bib9","series-title":"J Neurosurg Spine","first-page":"715","article-title":"Delayed subarachnoid hemorrhage following failed odontoid screw fixation","volume":"14","author":"Wilson","year":"2011","unstructured":"Wilson DAFusco DJTheodore N.Delayed subarachnoid hemorrhage following failed odontoid screw fixation. J Neurosurg Spine. 2011;14(6):715-718."},{"issue":"3","key":"bib10","series-title":"Korean J Spine","first-page":"289","article-title":"Delayed pharyngeal extrusion of an anterior odontoid screw","volume":"9","author":"Lee","year":"2012","unstructured":"Lee EJJang JWChoi SHRhim SC.Delayed pharyngeal extrusion of an anterior odontoid screw. Korean J Spine. 2012;9(3):289-292."},{"key":"bib11","series-title":"Case Rep Med","first-page":"2923696","article-title":"Passage of an anterior odontoid screw through gastrointestinal tract","volume":"2017","author":"Leitner","year":"2017","unstructured":"Leitner LBr\u00fcckmann CIGilg MMPassage of an anterior odontoid screw through gastrointestinal tract. Case Rep Med. 2017;2017:2923696."},{"issue":"suppl 1","key":"bib12","series-title":"Neurosurgery","first-page":"S47","article-title":"Antiplatelet therapy in flow diversion","volume":"86","author":"Tonetti","year":"2020","unstructured":"Tonetti DAJankowitz BTGross BA.Antiplatelet therapy in flow diversion. 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