The Vertebral Artery Pathology and Surgery
Our common interest in surgery of the vertebral artery was born in 1976, when as residents in the same hospital, we attended an attempt by two senior surgeons to treat an aneurysm of the vertebral artery at the C 3 level. Long discussions had preceded thi
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Springer-Verlag Wien New York
Bernard George, M .D. Department of Neurosurgery, H6pital Lariboisiere, Paris, France Claude Laurian, M.D. Department of Vascular Surgery, H6pital Saint Joseph, Paris, France
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© 1987 by Spnnger-Verlagj\Vlen Softcover reprint of the hardcover 1 st ed ition 1987
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With 97 Figures
Library of Congress Cataloging-in-Publication Data. The vertebral artery BIblioGeorge, Bernard, 1948graphy p. Includes mdex 1 Vertebral artery-Surgery 1 II . Title [DNLM 1 Vertebral Laurian, Claude, 1944Artery-surgery WG 595 V3 G 346v) RD 598 6 G46 1987 611' 413 87-9521
ISBN-13:978-3-7091-7454-8 001: 10.1007/978-3-7091-6967-4
e- ISBN-13:978-3-7091-6967-4
PREFACE
Our common interest in surgery of the vertebral artery was born in 1976, when as residents in the same hospital, we attended an attempt by two senior surgeons to treat an aneurysm of the vertebral artery at the C 3 level. Long discussions had preceded this unsuccessful trial, to decide if surgery was indicated and to choose the surgical route. Finally a direct lateral approach was performed, but access was difficult and correct treatment was impossible, resulting in only partial reduction of the aneurysmal pouch. Following this experience, we decided to seek a regular and well defined approach for exposition of the vertebral artery. Review of the literature indicated some surgical attempts, but the descriptions did not give the impression of safety and reproducibility. No landmark on the described surgical route appeared sufficiently reliable. Henry's anatomical work (1917) gave the only accurate description on vertebral artery anatomy, and it became the basis for our work. When the same patient was referred again one year later, after a new stroke in the vertebro-basilar system, we had behind us repetitive experience on cadavers of an original approach to the distal vertebral artery. We are very indebted to Dr. P. Derome and Dr. D. Guilmet for having accepted the proposals of the two young surgeons we were at the time, thus enabling us to perform our first revascularization of the distal vertebral artery. With juvenile enthusiasm, we had proposed and performed what can now be considered the most difficult technique, i.e. subclavian to distal vertebral artery by-pass because of absence of both post
