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Anatomical Consideration for Anterior Approach of Cervicothoracic Junction: A Computed Tomography Image Analysis
Eugene J Park1, Bo-Gil Jeong1, Woo-Kie Min1
1Department of Orthopedic Surgery, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea.
Insights
Anterior approaches to the cervicothoracic junction (CTJ) are challenging due to limited space and obstructing anatomy. This study analyzed key vascular angles and accessible surgical corridors, revealing crucial anatomical variations for safer anterior CTJ surgery.
Area of Science:
- Anatomy
- Surgical Planning
- Medical Imaging
Background:
- The cervicothoracic junction (CTJ) presents limited surgical space for posterior approaches.
- Anterior approaches to the CTJ are often necessary but are complicated by great vessels and the sternum.
- Understanding anatomical variations is crucial for optimizing anterior surgical corridors in the CTJ.
Purpose of the Study:
- To analyze anatomical structures relevant to the anterior approach in the cervicothoracic junction (CTJ).
- To evaluate the feasibility of previously reported surgical corridors for anterior CTJ access.
- To provide data for improved surgical planning and complication reduction in anterior CTJ procedures.
Main Methods:
- Retrospective analysis of neck computed tomography angiography (CTA) in 49 patients.
- Measurement of intercarotid artery angle (ICAA) and intercarotid artery distance (ICAD).
- Assessment of brachiocephalic trunk (BCT) shape and base position.
- Determination of accessible surgical levels (ML, SC, IC) for anterior CTJ approaches.
Main Results:
- Mean ICAA was 50.83°, mean ICAD was 33.38 mm; both were larger in men.
- The brachiocephalic trunk (BCT) was predominantly convex and located inside the body.
- Accessible levels for manubriotomy (ML), superior corridor (SC), and inferior corridor (IC) were T1, T3, and T5, respectively.
- Significant differences in ICAA, ICAD, and BCT base position were observed between sexes.
Conclusions:
- Preoperative analysis of vascular anatomy and corridor accessibility is essential for anterior CTJ surgery.
- Understanding patient-specific anatomy, including ICAA, ICAD, and BCT characteristics, aids in selecting optimal surgical corridors.
- This anatomical evaluation helps in reducing potential complications during anterior approaches to the cervicothoracic junction.
Background:
In the cervicothoracic junction (CTJ), there is limited working space to perform the posterior-only approach. Therefore, a combined anterior approach is required in some cases. However, the great vessels and sternum obstruct the anterior corridor and make the anterior approach difficult. We analyzed relevant anatomical structures encountered during the anterior approach in the CTJ and evaluated the feasibility of previously reported surgical corridors.
Methods:
We retrospectively examined 49 patients who underwent neck computed tomography angiography between January 2015 and May 2020. Using the coronal images, we measured the intercarotid artery angle (ICAA), intercarotid artery distance (ICAD), shape of the brachiocephalic trunk (BCT), and position of the BCT base. We then measured the most cranial level requiring manubriotomy for the anterior approach (ML), the most caudal level accessible through the superior corridor (SC), and the most caudal level through the inferior corridor (IC) according to the surgeon's line of sight using the sagittal axis image.
Results:
The mean ICAA and ICAD were 50.83° ± 15.23° and 33.38 ± 12.11 mm, respectively. Notably, BCT shape was of the convex type in most cases (42.9%), followed by the straight type (36.7%). In addition, the base of BCT was most commonly located inside the body (49%). Moreover, ICAA and ICAD were significantly greater in men. Although men mostly had the BCT base inside the body (64.3%), female mostly had it on the edge of the body (47.6%). Notably, ML showed the highest frequency (16.3%) in the T1 lower and upper bodies. Furthermore, through SC and IC, it was possible to approach the T4 lower body and T6 midbody, respectively. SC showed the highest frequency (16.3%) in the T3 lower body, and IC showed the highest frequency (20.4%) in the T5 midbody.
Conclusions:
ICAA and ICAD were larger and higher in men. BCT was convex and located inside the body in most cases. The accessible level of ML, SC, and IC were T1, T3, and T5, respectively. For the anterior approach in the CTJ, preoperative vascular and accessible level analysis of corridors is essential to decide on the appropriate corridor and reduce complications.
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