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Peer-reviewedCC BYSurgical and radiologic anatomy : SRA

The paracondylar process: anatomical relationships and clinical implications.

  • Beitris Chiu1,2
  • Nigel Williams3,4
  • Hong Kuan Kok5,6,7,8
  • Hamed Asadi9,10
  • Christen D Barras3,11
11 affiliations
  1. 1Faculty of Health and Medical Sciences, Adelaide University, Adelaide, South Australia, Australia. [email protected].
  2. 2Royal Adelaide Hospital, Adelaide, South Australia, Australia. [email protected].
  3. 3Faculty of Health and Medical Sciences, Adelaide University, Adelaide, South Australia, Australia.
  4. 4Paperscape, Adelaide, South Australia, Australia.
  5. 5Interventional Radiology Service, Northern Imaging Victoria, Northern Health, Victoria, Melbourne, Australia.
  6. 6NECTAR Research Group, Northern Health, Victoria, Melbourne, Australia.
  7. 7Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria, Melbourne, Australia.
  8. 8School of Health and Biomedical Sciences, RMIT University, Victoria, Melbourne, Australia.
  9. 9School of Medicine, Faculty of Health, Deakin University, Pigdons Road, Waurn Ponds, Victoria, Australia.
  10. 10Interventional Neuroradiology Service, Radiology Department, Austin Hospital, Victoria, Melbourne, Australia.
  11. 11Department of Radiology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
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Abstract

Purpose

The paracondylar process (PCP) is a rare and infrequently reported anatomical variant, where the incomplete separation of the lowest occipital sclerotome (proatlas) and uppermost cervical sclerotome results in a complete bony projection that meets with an epitransverse process of the atlas. We report a case that highlights the imaging and anatomical relationships of the PCP, particularly with the vertebral artery (VA), which has been given little attention in literature despite its important symptomatic and neurosurgical implications.Case presentation

A 55-year-old male presented with longstanding limitation to neck movement, left‑sided headaches and occasional dizzy spells. Cervical computed tomography (CT) imaging demonstrated a bony strut projecting inferiorly from the skull base, laterally adjacent to the left occipital condyle, articulating with the epitransverse process of C1. Though CT angiography was not performed, close examination of the course of the left vertebral artery on the soft tissue CT windows demonstrated an intimate relationship of the artery coursing immediately medial to the bony process in its V3 segment. We present a three-dimensional reconstruction prepared via segmentation and close reading of the soft tissue CT to illuminate the expected course of the vertebral artery and its' relationship to the PCP.Conclusion

This case demonstrates the anatomical and clinical significance of the paracondylar process (PCP), with a particular focus on its relationship with the vertebral artery. Whilst rare, this finding carries important clinical implications if surgical resection is to be contemplated.

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Cite

BibTeXRIS
BibTeX
@article{chiu2026paracondylar,
  title = {{The paracondylar process: anatomical relationships and clinical implications.}},
  author = {Beitris Chiu and Nigel Williams and Hong Kuan Kok and Hamed Asadi and Christen D Barras},
  journal = {Surgical and radiologic anatomy : SRA},
  year = {2026},
  month = oct,
  doi = {10.1007/s00276-026-04009-3},
  url = {https://europepmc.org/article/MED/42961473},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - The paracondylar process: anatomical relationships and clinical implications.
AU  - Beitris Chiu
AU  - Nigel Williams
AU  - Hong Kuan Kok
AU  - Hamed Asadi
AU  - Christen D Barras
PY  - 2026
DA  - 2026/10/30
JO  - Surgical and radiologic anatomy : SRA
DO  - 10.1007/s00276-026-04009-3
UR  - https://europepmc.org/article/MED/42961473
AB  - Purpose  The paracondylar process (PCP) is a rare and infrequently reported anatomical variant, where the incomplete separation of the lowest occipital sclerotome (proatlas) and uppermost cervical sclerotome results in a complete bony projection that meets with an epitransverse process of the atlas. We report a case that highlights the imaging and anatomical relationships of the PCP, particularly with the vertebral artery (VA), which has been given little attention in literature despite its important symptomatic and neurosurgical implications.Case presentation  A 55-year-old male presented with longstanding limitation to neck movement, left‑sided headaches and occasional dizzy spells. Cervical computed tomography (CT) imaging demonstrated a bony strut projecting inferiorly from the skull base, laterally adjacent to the left occipital condyle, articulating with the epitransverse process of C1. Though CT angiography was not performed, close examination of the course of the left vertebral artery on the soft tissue CT windows demonstrated an intimate relationship of the artery coursing immediately medial to the bony process in its V3 segment. We present a three-dimensional reconstruction prepared via segmentation and close reading of the soft tissue CT to illuminate the expected course of the vertebral artery and its' relationship to the PCP.Conclusion  This case demonstrates the anatomical and clinical significance of the paracondylar process (PCP), with a particular focus on its relationship with the vertebral artery. Whilst rare, this finding carries important clinical implications if surgical resection is to be contemplated.
SN  - 0930-1038
SN  - 1279-8517
ER  -