Anterolateral Approach to Subaxial Segment of the Cervical Vertebral Artery
The vertebral artery (VA) is classically divided into V1, V2, V3, and V4 segments. With consideration of the unique anatomy of the vertebral artery, the exposure of different cervical spine pathologies in close proximity of this artery, at each segment, h
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Abolfazl Rahimizadeh
Purpose To review the anatomy of the vertebral artery in subaxial cervical spine and to describe the tips and tricks in sound exposure of the vertebral artery in this segment.
Prerequisites For exposure of this part of vertebral artery, a thorough knowledge about the anatomy of this artery and the cervical roots in close proximity to this artery is necessary. The surgeon is better to be expert in microsurgical surgery which is necessary for dissection and mobilization of the artery. Since, exposure of this artery is mostly indicated in giant dumbbell schwannomas, the surgeon should be familiar with surgery of the smaller tumors of this kind.
Planning and Diagnostics
sary to show enlargement of the corresponding foramen in giant dumbbell schwannomas and possibility of destruction of the vertebral body and transverse processes in destructive tumors of the cervical spine. Axial, sagittal, and coronal T1- and T2-weighted and enhanced MRI are of great importance in particular in giant schwannomas or tumoral lesions of the cervical spine with lateral extension. Axial, 2D, and 3D computerized tomography are quite needed to show the enlargement or destruction of the foramina in dumbbell schwannomas and cervical spine tumors, respectively. The last but the most important for demonstration of any displacement or affection of the vertebral artery is CT angiography of the arteries of the cervical spine. Aplasia or hypoplasia of one of the vertebral arteries should be documented preoperatively.
Patient Positioning The patient should be in prone position with head slightly rotated to the contralateral side.
For dissection and isolation of the vertebral artery from a giant dumbbell schwannomas. Cervical spine AP and lateral and oblique views are neces-
Surgical Exposure of V2
A. Rahimizadeh (*) Pars Advanced and Minimally Invasive Medical Manners Research Center, Pars Hospital, Affiliated to Iran University of Medical Sciences, Tehran, Iran
The skin incision for exposing the V2 segment follows the medial edge of the middle portion of the sternocleidomastoid muscle (SM). The exposure has begun by opening the field
© Springer Nature Switzerland AG 2019 H. Koller, Y. Robinson (eds.), Cervical Spine Surgery: Standard and Advanced Techniques, https://doi.org/10.1007/978-3-319-93432-7_17
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between the medial aspect of the SM and the carotid-jugular bundle. Opening the connective tissue layer between these two structures, the anterior surface of the vertebral bodies can be reached. The prevertebral aponeurosis is exposed more laterally toward the longus coli which in its lateral side covers longus capitis. For finding the sympathetic chain below the aponeurosis and over longus capitis, this aponeurosis should be cut in vertical fashion [1–5]. With application of great care and with the aid of microscope, the chain can be identified. Once the sympathetic chain is exposed, it should be covered with aponeurosis of longus coli and retracted medially in order to guarantee chain’s
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