A rare variation of the vertebral artery

Variations of the vertebrobasilar arterial complex are important with regard to their potential clinical impact. We present an unusual case of the vertebral artery, in which the left vertebral artery in its ascent in the neck through the transverse foramina passed posteriorly between the transverse processes of C3 and C4 and supplied the posterior muscles of the neck without continuing intracranially. Albeit speculatively, we hypothesise that the variation of the vertebral artery reported here was caused by degeneration of the proximal portion of the left postcostal longitudinal anastomosis (i.e. C1 and C2 intersegmental arteries) in the context of a persistent third cervical intersegmental artery. Our case is unique in that the left vertebral artery terminated extracranially. Knowledge of the variations of the vertebrobasilar arterial complex is important for surgeons operating at the skull base, craniocervical junction, and cervical region, and for clinicians interpreting the imaging of this region.