Surgical anatomy of the upper vertebral artery

Abstract

A surgical approach to the upper vertebral artery between C1 and C2 is described. Following dissection of the posterior border of the sternocleidomastoid and the anterior border of the splenius capitis the two muscles are held apart and the levator scapulae is transected at its origin from C1. The cranial end of the vertebral artery can now be connected with the common carotid or external carotid arteries.

About the Suboccipital Part of the Vertebral Artery and the Neighboring Bone-Joint and Nerve Relationships

“…Differences between the sexes and right to left were not significant. In 37% the outer diameter of the artery was located 2.02 mm (0 to 4) dorsal to the back arch of the atlas, in 53.8%, 6.21 mm (4.5 to 8) dorsal to the back arch, and in 9.2%, 11.33 mm (9 to 13) dorsal to this landmark (Fig. 3).…”

The subatlantic triangle: gateway to early localization of the atlantoaxial vertebral artery

“…6). 29,46 Finally, the levator scapulae and splenius cervicis muscles are detached from the C-1 transverse process to expose the VA (Fig. 6B).…”

“…This approach is usually performed with the patient in a supine position, with the head turned contralaterally, or in the lateral position. 14,15,29,46 Therefore, this approach is ideal for an ECA-VA bypass, 10,15,27 as the carotid sheath and the VA are both exposed during the same surgical exposure.…”

“…This feature adds to the technical safety of this method, as no sharp dissection is needed to detach the muscles attached to the C-1 transverse process, which is a routine maneuver proposed in currently existing lateral approaches. 1,4,14,29,46 Such sharp dissection would endanger adjacent vascular structures, including the VA and the IJV. Using the subatlantic triangle, once the superficial muscles (SCM and splenius capitis) are detached from the superior nuchal line, no additional sharp muscle dissection is necessary to expose the atlantoaxial VA.…”