Course variability of the atlantic (V3) segment of vertebral artery: anatomical study with clinical implications
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Abstract
Background: The atlantic segment of vertebral artery (V3) located at the centre of the cranio-vertebral junction is known for its variability and asymmetry, and is either the target or on the way of numerous procedures in this region. The aim of the study was to visualise variability of V3 segment.
Materials and methods: The V3 segment was studied in 49 specimens of the suboccipital region injected with coloured gelatine. Direct measurements were performed and probabilistic maps were created using digital photography.
Results: The V3 segment has wavy course with possible lateral and significant postero-inferior expansions. In relation to the foramen transversarium the V3 reached up to 5 mm laterally, 23 mm posteriorly, 27 mm medially and up to 11 mm downward. Looking from the medial aspect the course of the V3 is less predictable compared to the lateral approach. Linear measurements and probabilistic maps revealed significant variability and large range of variation. There were 11 cases of V3 tortuosity found in studied material.
Conclusions: The complex and variable spatial conformation of V3 makes individual diagnostic and preoperative approach necessary.
Keywords: atlanto-occipital jointcranio-cervical junctionsuboccipital trianglecranio-vertebral junctionvertebral artery anatomyvertebro-basilar system
References
- Abd el-Bary TH, Dujovny M, Ausman JI. Microsurgical anatomy of the atlantal part of the vertebral artery. Surg Neurol. 1995; 44(4): 392–400; discussion 400.
- Bruneau M, Cornelius JF, George B. Antero-lateral approach to the V3 segment of the vertebral artery. Neurosurgery. 2006; 58(1 Suppl): ONS29–35; discussion ONS29.
- Cacciola F, Phalke U, Goel A. Vertebral artery in relationship to C1-C2 vertebrae: an anatomical study. Neurol India. 2004; 52(2): 178–184.
- Ciołkowski MK, Krajewski P, Ciszek B. A case of atlas assimilation: description of bony and soft structures. Surg Radiol Anat. 2014; 36(8): 833–836.
- Ciołkowski MK, Krajewski P, Ciszek B. A case of vertebral artery duplication at the level of atlas: anatomical description. Eur Spine J. 2014; 23 Suppl 2: 285–287.
- Duan S, Lv S, Ye F, et al. Imaging anatomy and variation of vertebral artery and bone structure at craniocervical junction. Eur Spine J. 2009; 18(8): 1102–1108.
- El-Gaidi MA, Eissa EM, El-Shaarawy EAA. Free-hand placement of occipital condyle screws: a cadaveric study. Eur Spine J. 2014; 23(10): 2182–2188.
- FIPAT Terminologia Neuroanatomica. Federative International Programme for Anatomical Terminology. 2017. https://fipat.library.dal.ca/ (February 2017).
- Ha W, Yang D, Gu S, et al. Anatomical study of suboccipital vertebral arteries and surrounding bony structures using virtual reality technology. Med Sci Monit. 2014; 20: 802–806.
- Harnsberger HR, Osborn AG, Macdonald AJ. Imaging anatomy: brain, head & neck, spine. Amirsys Pub Inc 2006.
- La Marca F, Zubay G, Morrison T, et al. Cadaveric study for placement of occipital condyle screws: technique and effects on surrounding anatomic structures. J Neurosurg Spine. 2008; 9(4): 347–353.
- Lang J, Kessler B. About the suboccipital part of the vertebral artery and the neighboring bone-joint and nerve relationships. Skull Base Surg. 1991; 1(1): 64–72.
- Lee HJ, Choi DY, Shin MH, et al. Anatomical feasibility for safe occipital condyle screw fixation. Eur Spine J. 2016; 25(6): 1674–1682.
- Osorio JA, Benet A, Hess CP, et al. Primary vertebral artery reanastomosis during retrosigmoid skull base approach following iatrogenic near-transection with monopolar electrocautery. Neurosurgery. 2014; 10 Suppl 4: 631–639.
- Ulm AJ, Quiroga M, Russo A, et al. Normal anatomical variations of the V₃ segment of the vertebral artery: surgical implications. J Neurosurg Spine. 2010; 13(4): 451–460.
- Yamaguchi S, Eguchi K, Kiura Y, et al. Posterolateral protrusion of the vertebral artery over the posterior arch of the atlas: quantitative anatomical study using three-dimensional computed tomography angiography. J Neurosurg Spine. 2008; 9(2): 167–174.
- Youssef AS, Uribe JS, Ramos E, et al. Interfascial technique for vertebral artery exposure in the suboccipital triangle: the road map. Neurosurgery. 2010; 67(2 Suppl Operative): 355–361.
