Neck Region

Suboccipital muscle anatomy and exposure the V2, V3 and V4 segments of the vertebral artery – anatomical dissection

This material is accepted for publication in Operative Neurosurgery journal (click on name to open):
Toma Spiriev, Vladimir Nakov, Jan F Cornelius. Photorealistic 3-Dimensional Models of the Anatomy and Neurosurgical Approaches to the V2, V3, and V4

3D Model - segments of the vertebral artery.

A far lateral craniotomy is simulated revealing 
the V4 segment of the vertebral artery:
Model. 1 The skin has been reflected and the trapezius, splenius and sternocleidomastoid muscles are presented.
Model. 2 The trapezius m. is mobilised and reflected caudally.
The splenius m. is presented. On the left side the postero-lateral fat pad between has been dissected an the IX nerve is presented.
Model. 3 Both splenius mm. are mobilized and reflected caudally.
The semispinalis capitis mm., longissimus and and levator scapuale mm. are presented.
The greateroccipital nerve is visibel on the right side.
Model. 4 The suboccpital triangle (superior and inferior oblique mm. as well as rectus capistis posterior major m.) containig the suboccipital venous plexus and vertebral artery is presented.
Model. 5 The muscles of the suboccpital triangle were removed on the left side and the fat pad with the suboccipital venous plexus and the vertebral artery were presented.
Model. 6 The vertebral artery is mobilised subperiostely. The suboccpital venous plexus is removed an the V2 and V3 segments of the vertebral artery are presented.
Model. 7 Part of the occipital bone and the mastoid were removed exposing the transverse and sigmoid sinuses. 
The postiro fossa dura is exposed.
Model. 8 The occipital condyle was partially removed.
Model. 9 The dura is opened and the caudal group of cerebellopontine angle nerves is presented (IX, X, XI). The V4 segment of the VA is presented.
Model. 7 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.