Stellate Ganglion Encircling Atypical Vertebral Artery

We present the case of an unusual course of the right vertebral artery with intra-foraminal entrance at C4, enveloped by an abnormal stellate ganglion. Case reports and literature mention these abnormalities independently, but it is uncommon to have them presented simultaneously. The close association of the vertebral artery and the stellate ganglion, especially in patients who harbor anomalies, could potentially cause lesions to the ganglion during clinical procedures. The anatomical variations are clinically significant in relation to procedures like endovascular intervention, stellate ganglion blocks, and anterior cervical surgical procedures. Complications of the sympathetic trunk and its ganglion can range from Horner’s Syndrome to severe hypertensive reactions. Clinical procedures should require the use of magnetic resonance imaging, computerized tomography, and ultrasound imaging, to reduce the risk of possible complications. Ultrasound techniques reduce the risk of harming the vertebral artery, while remaining vastly more practical and affordable than other techniques. This discovery allows for future breakthroughs in prevention and intervention of cervical vessels of iatrogenic injury during surgical procedures involving cervical vessels.