Bilateral arcuate foramen decompression for posterior circulation stroke in a child-case report and literature review.

INTRODUCTION: Posterior circulation stroke resulting from vertebral artery (VA) dissection in children is rare but may occur secondary to compression of the VA within the arcuate foramen (AF), a well-described congenital anomaly of the C1 vertebra. There is limited documentation of the surgical technique for VA decompression in such cases. OBJECTIVES: To review the literature on the surgical management of symptomatic AF and to describe a paediatric case of posterior circulation infarction secondary to VA dissection associated with bilateral AF. METHODS: A literature review was performed using PubMed and Google Scholar. Additionally, we report the case of a 15-year-old boy with bilateral AF who presented with posterior circulation infarction from VA dissection and underwent bilateral surgical VA decompression utilising 3D-printed intraoperative guides for operative planning and execution. RESULTS: Ten papers were identified comprising 106 patients who underwent surgical decompression for AF-related VA compression, predominantly managed via a posterior midline approach. In our case, surgical decompression was successfully achieved with stable intraoperative neurophysiological monitoring and no complications. Postoperative recovery was uneventful, and the patient remained stroke-free at 7-month follow-up with complete resolution of headaches and hypertension. CONCLUSIONS: AF-related VA compression represents a rare but potentially treatable cause of paediatric posterior circulation stroke. Careful assessment of cervical spine anatomy should be performed in cases of paediatric posterior circulation stroke, and surgical decompression may be considered when AF is identified.