Anterolateral approach to the V1 segment of the vertebral artery

We describe the normal anatomy, variations, and the surgical technique to expose and control the V1 segment of the vertebral artery (VA).

The VA V1 segment extends classically from the subclavian artery to the C6 transverse foramen. It courses obliquely upwards and posteriorly in the cervical fat tissue, at a distance of 5 to 10 mm from the C7 vertebral body. Along its course, the VA V1 segment is crossed by the inferior thyroid artery, the thoracic duct, and the sympathetic chain. For neurosurgeons, the safest approach is to expose the distal part of the V1 segment at the C6 transverse foramen level through an antero-lateral approach. Otherwise, direct exposure of the subclavian artery requires vascular surgery expertise.

Surgical exposure of the VA V1 segment can be indicated on approaching the C6-C7 intervertebral disc space for degenerative disease or on treating tumoral processes in its vicinity. With developments of endovascular techniques, revascularization procedures are more rarely indicated nowadays.

Perfect knowledge of the anatomy and of the surgical technique permits a safe exposure and control of the VA V1 segment.