Abstract
The vertebral artery (VA) at the cranio-vertebral junction is in its third segment (V3) and has a complex course between the transverse foramen (TF) of C2 and the foramen magnum (FM) dura. There are two main routes which permit to safely expose and control the VA: the posterolateral and the anterolateral approaches. The most important technical trick for a safe exposure of the VA is the preservation of the periosteal sheath surrounding the VA and its venous plexus. The access to the VA gives the possibility of release of extrinsic intermittent VA compression (Bow Hunter syndrome) and of course to revascularize the vertebro-basilar system by a venous graft bypassing an occlusive lesion, an aneurysm, or a tumor. The VA control gives also a better access to FM tumors through the posterolateral approach or to CVJ tumors through the anterolateral approach, or to jugular foramen (JF) tumors through the juxtacondylar approach, which is an anterolateral approach extension. Mortality and morbidity related to the VA exposure should be very limited, including only painful stiffness of the sterno-mastoid muscle due to overstretching of the accessory nerve.
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References
Bruneau M, George B. Foramen magnum meningiomas: detailed surgical approaches and technical aspects at Lariboisière hospital and review of the literature. Neurosurg Rev. 2008;31:19–32; discussion 32–3. https://doi.org/10.1007/s10143-007-0097-1.
Bruneau M, George B. Surgical approaches to the V3 segment of the vertebral artery. In: George B, Bruneau M, Spetzler RF, editors. Pathology and surgery around the vertebral artery. Paris: Springer; 2011. p. 329–60.
Bruneau M, George B. The juxtacondylar approach to the jugular foramen. Neurosurgery. 2008;62:75–8; discussion 80–1. https://doi.org/10.1227/01.neu.0000317375.38067.55.
Bruneau M, Cornelius JF, George B. Antero-lateral approach to the V3 segment of the vertebral artery. Neurosurgery. 2006;58:ONS29–35; discussion ONS29–35
Morimoto T, Nakase H, Sakaki T, Matsuyama T. Extrinsic compression Bow hunter’s stroke. In: George B, Bruneau M, Spetzler RF, editors. Pathology and surgery around the vertebral artery. Paris: Springer; 2011. p. 473–87.
Bassiouni H, Ntoukas V, Asgari S, et al. Foramen magnum meningiomas: clinical outcome after microsurgical resection via a posterolateral suboccipital retrocondylar approach. Neurosurgery. 2006;59:1177–85; discussion 1185–7. https://doi.org/10.1227/01.NEU.0000245629.77968.37.
Matsuyama T, Morimoto T, Sakaki T. Comparison of C1-2 posterior fusion and decompression of the vertebral artery in the treatment of Bow hunter’s stroke. J Neurosurg. 1997;86:619–23. https://doi.org/10.3171/jns.1997.86.4.0619.
Yang T, Tariq F, Duong HT, Sekhar LN. Bypass using V2-V3 segment of the vertebral artery as donor or recipient: technical nuances and results. World Neurosurg. 2014;82:1164–70. https://doi.org/10.1016/j.wneu.2014.02.034.
Bruneau M, George B. Chapter 26: Surgical technique for the resection of tumors in relation with the V3 and V4 segments of the vertebral artery. In: George B, Bruneau M, Spetzler RF, editors. Pathology and surgery around the vertebral artery. Paris: Springer; 2011. p. 362–405.
George B, Lot G. Anterolateral and posterolateral approaches to the foramen magnum: technical description and experience from 97 cases. Skull Base Surg. 1995;5:9–19.
Nanda A, Vincent DA, Vannemreddy PS, et al. Far-lateral approach to intradural lesions of the foramen magnum without resection of the occipital condyle. J Neurosurg. 2002;96:302–9. https://doi.org/10.3171/jns.2002.96.2.0302.
Lanzino G, Paolini S, Spetzler RF. Far-lateral approach to the craniocervical junction. Neurosurgery. 2005;57:367–71; discussion 367–71
Sharma BS, Gupta SK, Khosla VK, et al. Midline and far lateral approaches to foramen magnum lesions. Neurol India. 1999;47:268–71.
Spektor S, Anderson GJ, McMenomey SO, et al. Quantitative description of the far-lateral transcondylar transtubercular approach to the foramen magnum and clivus. J Neurosurg. 2000;92:824–31. https://doi.org/10.3171/jns.2000.92.5.0824.
Kratimenos GP, Crockard HA. The far lateral approach for ventrally placed foramen magnum and upper cervical spine tumours. Br J Neurosurg. 1993;7:129–40.
Rhoton AL. The far-lateral approach and its transcondylar, supracondylar, and paracondylar extensions. Neurosurgery. 2000;47:S195–209.
Babu RP, Sekhar LN, Wright DC. Extreme lateral transcondylar approach: technical improvements and lessons learned. J Neurosurg. 1994;81:49–59. https://doi.org/10.3171/jns.1994.81.1.0049.
Sen CN, Sekhar LN. An extreme lateral approach to intradural lesions of the cervical spine and foramen magnum. Neurosurgery. 1990;27:197–204.
Salas E, Sekhar LN, Ziyal IM, et al. Variations of the extreme-lateral craniocervical approach: anatomical study and clinical analysis of 69 patients. J Neurosurg. 1999;90:206–19.
Acikbas SC, Tuncer R, Demirez I, et al. The effect of condylectomy on extreme lateral transcondylar approach to the anterior foramen magnum. Acta Neurochir. 1997;139:546–50.
Morimoto T, Kaido T, Uchiyama Y, et al. Rotational obstruction of nondominant vertebral artery and ischemia. Case report. J Neurosurg. 1996;85:507–9. https://doi.org/10.3171/jns.1996.85.3.0507.
Bruneau M, Makiese O, Cornelius JF, et al. Chapter 44: The juxtacondylar approach to the jugular foramen. In: George B, Bruneau M, Spetzler RF, editors. Pathology and surgery around the vertebral artery. Paris: Springer; 2011. p. 641–68.
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Bruneau, M., George, B. (2020). Surgery Involving the Vertebral Artery at the Cranio-vertebral Junction. In: Tessitore, E., Dehdashti, A., Schonauer, C., Thomé, C. (eds) Surgery of the Cranio-Vertebral Junction. Springer, Cham. https://doi.org/10.1007/978-3-030-18700-2_28
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