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Anterior Cervical Approach to Vertebral Artery Exposure: A Step-By-Step Surgical Technique Guide By the Cervical
Iyan Younus1, Kento Yamanouchi1, John M Rhee2
1Department of Neurosurgery, Center for Neurosciences and Spine, Virginia Mason Franciscan Health, Seattle, WA.
Introduction:
This guide reviews vertebral artery (VA) anatomy and anomalies, highlights key considerations for VA injury (VAI) prevention, and provides a step-by-step technique guide for VA exposure in the event of an intraoperative VAI.
Surgical Technique:
VA exposure begins with packing to obtain hemostatic control. If direct repair is necessary and feasible, dissection is carried out laterally beyond the uncus to expose the transverse process (TP) using a Kerrison rongeur at both the superior and inferior levels. The anterior portion of the TP is removed with a Kerrison to unroof the transverse foramen. Temporary clips can be applied proximal and distal to the injured segment of the VA. Primary repair of the injured VA can be attempted using 7-0 or 8-0 prolene sutures. It is critical to not use hemostatic agents that are flowable, expandable, or contain thrombin as they may pose a risk of embolism and subsequent stroke or neurological injury. Postoperatively, the artery is evaluated with angiography.
Conclusion:
While iatrogenic VAI is rare, it can lead to severe complications. Here, we present an overview of preoperative and postoperative considerations and a step-by-step technique guide for VA exposure from an anterior approach to the cervical spine.
