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
Annotations Right vertebral artery, Brachiocephalic trunk, Right common carotid artery, Internal thoracic (mammary) artery, Left common carotid artery stump, Left subclavian artery, Left vertebral artery, Basilar artery, AICA, SCA, Posterior cerebral artery, Internal carotid artery, Anterior cerebral artery, Anterior communicating artery, Middle cerebral artery, Confluens sinuum, Transverse sinus, Sigmoid sinus
Annotations Right vertebral artery, Brachiocephalic trunk, Right common carotid artery, Internal thoracic (mammary) artery, Left common carotid artery stump, Left subclavian artery, Left vertebral artery, Basilar artery, AICA, SCA, Posterior cerebral artery, Internal carotid artery, Anterior cerebral artery, Anterior communicating artery, Middle cerebral artery, Confluens sinuum, Transverse sinus, Sigmoid sinus
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
Annotations Sternocleidomastoid m., Levator scapulae m., Splenius capitis m., Occipital a., Auricularis magnus n., Dissection plane, Fat pad, Submandibular gland, Facial vvein
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
Annotations Sternocleidomastoid m., Levator scapulae m., Splenius capitis m., Occipital a., Auricularis magnus n., Dissection plane, Fat pad, Submandibular gland, Facial vvein
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.
Annotations Sternocleidomastoid m., XI n., X n., ICA, ECA, IX n., Jugular v., Facial v., Digastric m., Fat pad, Occipital a., Splenius capitis m., Levator scapulae m., Submandibular gland, CCA, XII n.
The CCA, ICA and ECA are presented, as well as the jugular vein.
The vagus, glossopharyngeal and hypoglossal nerves are visible.
Annotations Sternocleidomastoid m., XI n., X n., ICA, ECA, IX n., Jugular v., Facial v., Digastric m., Fat pad, Occipital a., Splenius capitis m., Levator scapulae m., Submandibular gland, CCA, XII n.
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. *
Annotations XI n., Levator scapulae m., Longissimus m., Digastric m., Accessory n., Vagus n., ICA, ECA, Glossopharyngeal n., Internal jugular v., Facial v., Hypoglossal n., Sternocleidomastoid m., Splenius and longisimus mm., Occipital a., Inferior oblique m., Superior oblique m., Rectus capitis posterior major m., Spinous process of C2, Transverse process of C1
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. *
Annotations XI n., Levator scapulae m., Longissimus m., Digastric m., Accessory n., Vagus n., ICA, ECA, Glossopharyngeal n., Internal jugular v., Facial v., Hypoglossal n., Sternocleidomastoid m., Splenius and longisimus mm., Occipital a., Inferior oblique m., Superior oblique m., Rectus capitis posterior major m., Spinous process of C2, Transverse process of C1
Model. 4 The vertebral artery is exposed by detachment of the muscles from the transverse process of C1 and opening of the latter.
Annotations Vertebral a., C1 posterior arch, C2 nerve root, Suboccipital triangle muscle, C2 lateral mass, Digastric m., Splenius and longissimus mm., Sternocleidomastoid m., Accessory n., Vagus n., ICA, ECA, Glossopharyngeal n., Jugular v., Facial v., Hypoglossal n., Occipital a., C3 nerve root, Longus capitis m.
Annotations Vertebral a., C1 posterior arch, C2 nerve root, Suboccipital triangle muscle, C2 lateral mass, Digastric m., Splenius and longissimus mm., Sternocleidomastoid m., Accessory n., Vagus n., ICA, ECA, Glossopharyngeal n., Jugular v., Facial v., Hypoglossal n., Occipital a., C3 nerve root, Longus capitis m.
Model. 5 Next the digastric m. (posterior belly) is removed.
The facial nerve exiting the stylomastoid foramen is exposed.
Annotations Facial n., Occipital a., Vertebral a., C1 posterior arch, C2 posterior arch, Accessory n., Vagus n., Common carotid a., Glossopharyngeal n., Hypoglossal n., External carotid a., Internal carotid a., Digastric m., Internal jugular v., Facial v., Sternocleidomastoid m., Spine of Henle, Temporalis m., Asterion
The facial nerve exiting the stylomastoid foramen is exposed.
Annotations Facial n., Occipital a., Vertebral a., C1 posterior arch, C2 posterior arch, Accessory n., Vagus n., Common carotid a., Glossopharyngeal n., Hypoglossal n., External carotid a., Internal carotid a., Digastric m., Internal jugular v., Facial v., Sternocleidomastoid m., Spine of Henle, Temporalis m., Asterion
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.
Annotations Sympathetic chain, Longus capitis m., Internal carotid a., Accessory n., Facial n., Occipital a., Vertebral a., Sternocleidomastoid m., Vagus n., Internal jugular v., Facial v., External carotid a., C3 nerve root, Scalenus medius m., Longus colli m.
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.
Annotations Sympathetic chain, Longus capitis m., Internal carotid a., Accessory n., Facial n., Occipital a., Vertebral a., Sternocleidomastoid m., Vagus n., Internal jugular v., Facial v., External carotid a., C3 nerve root, Scalenus medius m., Longus colli m.
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.
Annotations Longus capitis m., Transverse process of C3, Transverse process of C4, C3 nerve root, C4 nerve root, Sympathetic chain, Internal carotid a., Vagus n., Internal jugular v., Hypoglossal n., Accessory n., Sternocleidomastoid m., Vertebral a., Occipital a., Facial n., C2 lamina, C1 posterior arch, Perivertebral venous plexus, Scalenus medius m.
The transverse processes of C3 and C4 vertebrae are presented.
Annotations Longus capitis m., Transverse process of C3, Transverse process of C4, C3 nerve root, C4 nerve root, Sympathetic chain, Internal carotid a., Vagus n., Internal jugular v., Hypoglossal n., Accessory n., Sternocleidomastoid m., Vertebral a., Occipital a., Facial n., C2 lamina, C1 posterior arch, Perivertebral venous plexus, Scalenus medius m.
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.
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.
Annotations Vertebral artery - vertical portion, Vertebral artery - horizontal portion
Annotations Vertebral artery - vertical portion, Vertebral artery - horizontal portion