الفهرس 
Vertebral Artery AnatomyOnly 14 pages are availabe for public view
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Abstract
The complaint of the presented cases varied widely between Neck pain in 30 case, Headache in 11 case, Upper extremity Numbness in 10 case, Dysarthria and Swallowing difficulties in 1 case, Positional vertigo & syncopal attacks in 1 case, Progressive Weakness and Myelopathy in 8 cases, DCL and coma in 1 case, Dizziness and gait disturbance in 7 cases, Headache and eye tremors in 1 case. 33 case operated by posterior approach which is the most commonly used approach. Anterior Approach: 3 cases: 1 odontoid screw and 2 Cases Retropharyngeal approach (1st stage of combined approach) Far lateral approach: 1 Case. o Decompression without Fusion: 15 Cases= 42.9 % including 11 Chiari malformation cases, 3 neoplastic cases and one case of cysticercosis. One case with degenerative pannus and instability at the craniocervical junction presented with dysarthria and swallowing difficulties misdiagnosed before as stroke markedly improved postoperative. One case presented with positional vertigo and syncobal attacks when bending the head, the patient has Ehler-Danlos syndrome with hyper laxity at the craniocervical junction, markedly improved after OC fusion. Eight patients presented with progressive weakness and mylopathy and Seven Patients in our Thesis had Dizziness and gait disturbance which shown marked improvement of weakness and continue to improve with physical therapy and occupational therapy. We had one child presented post Motor vehicle accident with Coma and Occipito atlanto axial dissociation, External ventricular drain was placed and ICU stabilization, then OC Fusion was done and kept in ICU till weaned from EVD and continue to show improvement. One case among Chiari cases showed head and eye tremors which showed marked improvement postoperatively. Long term follow showed failure of fusion and redo cases are mentioned in complications Complications: Failure of fusion and redo surgery: two cases with failed fusion 5.7%, the first patient we redo surgery in the form of OCCervical (pedicle screws) fusion and augmentation of fusion after 5 months of 1st surgery, and the second patient was Rheumatoid patient 4 month after surgery, we removed the system and kept in hard collar. Wound infection: one case 2.9%, the case was rheumatoid with multi organ affection, osteoporosis and on high dose steroid therapy, infection of the wound, we removed the system and kept in hard collar. Also, we encountered hypoglossal nerve dysfunction in one tumor case 2.9%, in the form of tongue deviation, protrusion, swallowing difficulties and dysarthria, partially improved with conservative measures and speech therapy.