The paracondylar process: anatomical relationships and clinical implications.
Beitris Chiu, Nigel Williams, Hong Kuan Kok et al.
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Case in brief
A 55-year-old man with longstanding restricted neck movement, left-sided headaches and occasional dizziness underwent cervical CT. Imaging showed a bony strut extending inferiorly from the skull base, lateral to the left occipital condyle, and articulating with the epitransverse process of C1, consistent with a paracondylar process. Although CT angiography was not performed, soft-tissue CT windows showed the left vertebral artery passing immediately medial to the process in its V3 segment. Three-dimensional reconstruction illustrated this anatomical relationship.
What made this case unusual
The case draws attention to the close relationship between the paracondylar process and the vertebral artery, an anatomical detail the authors note has received little attention despite its potential symptomatic and neurosurgical implications.
Diagnostic / clinical pearl
When a paracondylar process is identified, assess the vertebral artery’s course on available imaging; here, the left V3 segment passed immediately medial to the bony projection.
Why it matters
This relationship is relevant if surgical resection is contemplated, because the artery’s proximity may affect operative planning.