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Tailored vertebral artery mobilisation in complex craniovertebral junction surgery

Ved Prakash Maurya1, Ashutosh Kumar1, Anantha Chaitanya J1

  • 1Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, 226014, India.

Neurosurgical Review
|January 29, 2026
PubMed

Insights

Tailored vertebral artery mobilization (VAM) offers a safe surgical approach for complex craniovertebral junction anomalies involving aberrant vertebral arteries. This technique improves patient outcomes by decompressing neurovascular structures and stabilizing the C1-C2 joint.

Area of Science:

  • Neurosurgery
  • Orthopedic Surgery
  • Vascular Surgery

Background:

  • Complex craniovertebral junction (CVJ) anomalies present diverse challenges, including atlantoaxial dislocation and aberrant vertebral artery (VA) courses.
  • Accessing the C1-C2 joint for surgical management is often complicated by the anomalous anatomy of the VA, posing risks to neurovascular structures.

Purpose of the Study:

  • To describe surgical nuances and share experience with tailored vertebral artery mobilization (VAM) for managing complex CVJ anomalies.
  • To evaluate the efficacy and safety of VAM in providing a surgical corridor for C1-C2 joint access without increasing neurovascular injury risk.

Main Methods:

  • Retrospective observational study of 32 patients with CVJ anomalies operated between January 2018 and December 2024.
  • Collected clinical, radiological, and operative data; compared outcomes of patients with anomalous VA course (study group) versus normal VA course (control group).
  • Assessed clinicoradiological improvement at three-month follow-up using Nurick's grading scale.

Main Results:

  • A total of 32 patients were analyzed, with a median pre-operative Nurick's grade of 4.
  • Eighteen patients underwent unilateral VAM, and fourteen underwent bilateral VAM.
  • Statistically significant improvement in median post-operative Nurick's grade to 3 (P=0.002) at three months, with a mean follow-up of 28.5 months and no procedure-related mortality.

Conclusions:

  • Tailored VAM is an effective surgical strategy for complex CVJ pathologies with anomalous VA.
  • This technique establishes a safe surgical corridor for C1-C2 joint access, minimizing risks to neurovascular structures.
  • VAM contributes to improved stability and patient recovery in CVJ anomaly management.

Keywords:
Atlantoaxial dislocationCraniovertebral junctionNurick’s gradeVertebral angiogramVertebral artery

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