Neck Region

Anterolateral anatomical neck dissection to the V2 and V3 segments of the vertebral artery

This material is accepted for publication in Operative Neurosurgery journal and is under production. More details will come soon.

3D Model - segments of the vertebral artery.

A far lateral craniotomy is simulated revealing 
the V4 segment of the vertebral artery:
Model. 1 Skin incision is made along medial border of the sternocleidomastoid muscle to the occipital region posteriorly reflecting the skin and subcutaneous tissue.
The trapezius m. is mobilized and reflected inferiorly.
The deeper suboccipital muscles are presented – splenius and levator scapulae mm. The sternocleidomastoid muscle is exposed and the auricularis magnus nerve is presented.
The dissection plane medial to the anterior border of the sternocleidomastoid m. is initiated
Model. 2 The IX nerve is presented and part of the fat pad is removed. 
The CCA, ICA and ECA are presented, as well as the jugular vein. 
The vagus, glossopharyngeal and hypoglossal nerves are visible.
Model. 3 The sternocleidomastoid, splenius and longissimus mm. which are mobilezed
and reflected, exposing the suboccipital triangle muscles - superior and inferior oblique, rectius capitis posterior major. 
The transverse process of C1 is exposed the the muscles attached to it: * superior oblique m. * inferior oblique m. * rectius capitis posterior major m. * rectus capitis lateralis m. *
Model. 4 The vertebral artery is exposed by detachment of the muscles from the transverse process of C1 and opening of the latter.
Model. 5 Next the digastric m. (posterior belly) is removed. 
The facial nerve exiting the stylomastoid foramen is exposed.
Model. 6  The internal carotid artery and jugular veins are retracted medially. 
The sympathetic chain over the longus coli m. is visible. 
The latter is very important for the surgical exposure of the V2 segment of the vertebral artery.
Model. 7 The longus coli m. is mobilized and the C3, C4 nerve roots are revealed.
The transverse processes of C3 and C4 vertebrae are presented.
Model. 8 The longus coli m. is resected and the transverse foramina of C3 and C4 vertebrae are opened. 
The vertebral artery V2 segment is exposed subperiosteally.
Model.9  In neutral position, the vertical and horizontal portions of the V3 segment of the vertebral artery are perpendicular. After the head is rotated to contralateral side and extended (as required by the anterolateral approach) both segments are stretched and run parallel, only separated by the groove of the posterior arch of the atlas.