Simultaneous lateral and posterior ponticles resulting in the formation of a vertebral artery tunnel of the atlas: Case report and review of the literature

R. Shane Tubbs, Mohammadali Mohajel Shoja, Ghaffar Shokouhi, Ramin M. Farahani, Marios Loukas, W. Jerry Oakes

Research output: Contribution to journalArticle

12 Scopus citations


The foramen arcuale is infrequently found and is potentially a clinically/surgically significant anatomical variation of the atlas. When present, the vertebral artery travels through this bony ring after exiting the transverse foramen of the atlas and prior to entering the cranium. We present a case of an adult female skeleton noted to harbor both a foramen arcuale and a lateral ponticle that resulted in the formation of a canal for the vertebral artery. The literature regarding these osteological structures is reviewed regarding their presence and potential clinical significance. The simultaneous occurrence of fully developed lateral and posterior ponticuli resulting in encasement of the third part (atlanta/segment) of the vertebral artery appears to be very rare. Based on the literature regarding only foramina arcuale and their presence predisposing one to symptomatic entrapment, additional compression, as seen in our specimen, of the vertebral artery by a lateral ponticle could very likely result in stenosis of the vertebral artery.

Original languageEnglish (US)
Pages (from-to)43-46
Number of pages4
JournalFolia Neuropathologica
Issue number1
StatePublished - Jan 1 2007
Externally publishedYes



  • Anatomy
  • Atlas
  • Cervical
  • Craniocervical
  • Neck
  • Variation

ASJC Scopus subject areas

  • Pathology and Forensic Medicine
  • Clinical Neurology

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