Advanced Cranial Approaches

Anterolateral approach to V2 and V3 segments of the vertebral artery - surgical steps

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 Anterolateral approach to the left vertebral artery.
Reverse hockey stick incision is made along the medial border of the sternocleidomastoid m. 
The latter is exposed.
Model.2  The digastric m. is exposed and the fat pad of the postero-lateral neck region.
Model. 3 The jugular vein is exposed and the fat around the XI nerve is removed. 
The nerve is presented.
Model.4  The digastric m. (posteior belly) was transected revealing the C1 transverse process and the occipital artery. 
The fat pad has between mobilized and reflected inferiorly over the XI nerve in order to protect the latter.
Model. 5 The C1 transverse process and posterior arch are
exposed by mobilizing the muscles (levator scapulae, superior and inferior oblique). 
The C2 nerve root is revealed and the vertebral artery V2 segment.
Model.6  The transverse foramen has been opened and the V2 and V3 segments of the vertebral artery revealed.
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.