Summary
A lateral route between the SCM and the lateral border of the internal jugular vein is defined from an anatomical study for exposure of the VA. It offers the simplest route for controlling any part or the whole length of the VA, including its intracranial portion. Surgical indications are discussed on the basis of our experience in eight cases with, in all cases, control of the VA in its third segment between C 2 and the foramen magnum. Arteriovenous malformations are the most frequent indications; two cases were treated by direct approach and one by exclusion and anastomosis between the internal carotid artery and the vertebral artery at C 1-C 2. Tumours of the lateral cervical space (one haemangiopericytoma and one jugular glomus tumour) or of the posterior fossa extruding out of the foramen magnum or the jugular foramen (one meningioma) may required control of the VA. Traumatic lesions (one case) or compression by an osteophytic spur are also indications for this approach. Wall lesions of the VA (aneurysm or stenosis) are best treated by exclusion and anastomosis between either the carotid or the subclavian artery and the vertebral artery at C 1-C 2 level. One case of aneurysmal dysplasia was cured by anastomosis between the subclavian artery and the vertebral artery at C 1-C 2 with a saphenous vein graft and clipping of the VA proximal to the by-pass. Radiological examinations are fundamental for diagnosis, treatment when embolization is necessary, and choice of surgical treatment, according to the importance of the contralateral VA and the medullary branches.
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References
Avellanosa, A. M., Glasauer, F. E., Young, S. C., Traumatic vertebral arteriovenous fistula associated with cervical spine fracture. J. Trauma17 (1977), 885–888.
Bartal, A. D., Lery, M. J., Excision of a congenital suboccipital vertebral arterio-venous fistula. J. Neurosurg.37 (1972), 452–456.
Binkley, F. M., Wylie, E. Y., A new technique for obliteration of cerebrovascular arteriovenous fistula. Arch. Surg.106 (1973), 524–527.
Chou, S. N., French, L. A., Arteriovenous fistula of vertebral vessels in the neck. J. Neurosurg.22 (1965), 77–80.
Chou, S. N., Story, J. L., Seljeskog, E., French, L. A., Further experience with arteriovenous fistula of vertebral artery in the neck. Surgery62 (1967), 779–788.
Clark, K., Perry, M. O., Carotid-vertebral anastomosis an alternative technic for repair of the subclavian steal syndrome. Ann. Surg.163 (1966), 414–416.
Corkill, G., French, B. H., Michos, C., Corb, C. A., Mims, T. J., External carotid vertebral anastomosis for vertebro-basilar insufficiency. Surg. Neurol.7 (1977), 109–115.
Cormier, J. M., Laurian, C., Surgical management of vertebro-basilar insufficiency. J. cardiovasc. Surg.17 (1976), 205–223.
Debrun, G., Lacour, P., Caron, J. P., Hurth, M., Comoy, J., Keravel, Y., Detachable balloon and calibrated leak balloon techniques in the treatment of cerebral vascular lesions. J. Neurosurg.49 (1978), 635–649.
Elkin, D. C., Herris, M. H., Arteriovenous aneurysm of the vertebral vessels. Report of ten cases. Ann. Surg.124 (1946), 934–951.
Fredy, D., Hugonet, P., Missir, O., Thiebot, J., Bories, J., Obstruction des vaisseaux cervicaux à destinée encéphalique. Problèmes hémodynamiques. Noeud de Bosniak. J. Neurorad.53 (1978), 203–224.
Jefferson, G., Bailey, R. A., Kerr, A. S., Suboccipital arteriovenous aneurysm of vertebral artery. J. Bone Jt. Surg.38 (1956), 114–127.
Goodman, S. J., Hasso, A., Kirkpatrick, D., Treatment of vertebro-jugular fistula by balloon occlusion. J. Neurosurg.43 (1975), 362–367.
Hakuba, A., Haschi, K., Fujitani, K., Ikuno, H., Nakamura, T., Inoue, Y., Jugular Foramen neurinomas. Surg. Neurol.11 (2) (1979), 83–94.
Henry, A. K., Extensive exposure. Edinburgh: E. S. Livingstone. 1966.
Kornmesser, I. W., Bergan, J. J., Anatomic control of vertebral arterio-venous fistulas. Surgery75 (1974), 80–86.
Launan, C., George, B., Abord de l'artère vertébrale extracranienne. Etude anatomique. Intérêt chirurgical. Nouv. Press. Méd.8 (1979), 433–436.
Matas, R., Traumatisms and traumatic aneurysms of the vertebral artery and their surgical treatment with report of a cured case. Ann. Surg.18 (1893), 477–516.
Nagashima, C., Iwasaky, T., Kewanuma, S., Traumatic arteriovenous fistula of the vertebral artery with spinal cord symptoms. J. Neurosurg.46 (1977), 681–687.
Pasztor, E., Decompression of vertebral artery in cases of cervical spondylosis. Surg. Neurol.9 (1978), 371–377.
Sher, M. H., Meyer, N. I., Lenhard, H. F., Trämmer, M. J., Arteriovenous fistula involving the vertebral artery. Ann. Surg.163 (1966), 408–413.
Schumacker, A. B., Campbell, R. L., Heinmburger, R. F., Operative treatment of vertebral arteriovenous fistulas. J. Trauma.6 (1966), 3–18.
Verbiest, H., Extracranial and cervical arteriovenous aneurysms of the carotid and vertebral arteries. Johns Hopkins Med. J.122 (1968), 350–357.
Waga, S., Handa, J., Terauta, T., Handa, H., Traumatic vertebral arteriovenous fistula. Surg. Neurol.2 (1974), 279–281.
Weinberg, P. E., Flom, R. A., Traumatic vertebral arteriovenous fistula. Surg. Neurol.1 (1973), 162–167.
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George, B., Laurian, C. Surgical approach to the whole length of the vertebral artery with special reference to the third portion. Acta neurochir 51, 259–272 (1980). https://doi.org/10.1007/BF01406753
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DOI: https://doi.org/10.1007/BF01406753