Craniovertebral junction surgery usually requires the exposure of the third segment of the vertebral artery (V3). However, the complexity of musculature, a relatively high incidence of anomalies in the course of the vertebral artery (VA), and the presence of a rich venous plexus in this region make the V3 exposure challenging with a high risk of serious complications while taking down the suboccipital muscles in a single layer. A muscle dissection in interfascial layers, however, overcomes the drawbacks inherent in a blind dissection of the V3 as each of the muscles represents substantial landmark aiding subsequent step of the procedure and thus helping identify underlying anatomical structure early and safely. Moreover, along with a bloodless VA dissection off its surrounding venous plexus, it permits a safe and comfortable V3 exposure during the surgically demanding procedures.
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Ministerstvo Zdravotnictví Ceské Republiky (15-29021A) Dr. Vladimir Balik Palacky University Olomouc (LF 2019_003) Dr. Vladimir Balik Ministerstvo Školství, Mládeže a Tělovýchovy (LO1304, LM2015091) Dr. Vladimir Balik European Regional Development Fund (ENOCH CZ.02.1.01/0.0/0.0/16_019/0000868) Dr. Vladimir Balik.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
The study was performed according to the ethical standards of the Institutional Review Board of the Asahikawa Red Cross Hospital.
Patients’ consents were obtained from all participants, even though their identity was concealed and anonymity guaranteed in the publication.
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