A Contralateral Transcondylar Fossa Approach with Bilateral V3 Segment Exposure for Repairing Complex Vertebral Artery Aneurysms

Ota, Nakao; Miyama, Masataka; Miyazaki, Takanori; Kinoshita, Yu; Matsukawa, Hidetoshi; Sakakibara, Fumihiro; Saito, Norihiro; Maeda, Shiro; Noda, Kosumo; Tsuboi, Toshiyuki; Kamiyama, Hiroyasu; Tokuda, Sadahisa; Kamada, Kazuhiro

doi:10.1016/j.wneu.2016.12.033

Cited by 6 publications

(9 citation statements)

References 28 publications

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“…[10] Ota et al reported the trapping and aneurysmectomy for complex right VA aneurysm which deviated to the left using the contralateral (left-sided) transcondylar fossa approach with bilateral V3 exposure. [11] This is the first report about the new technique for the unilateral far lateral approach which provides bilateral V3 segment exposure for proximal control during surgery.…”

Section: Discussion and Review Articlementioning

confidence: 99%

Contralateral transcondylar fossa approach with bilateral V3 segment exposure for clipping of vertebral artery aneurysm which deviates across midline: A case report and review article

et al. 2019

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Section: Discussion and Review Articlementioning

confidence: 99%

Contralateral transcondylar fossa approach with bilateral V3 segment exposure for clipping of vertebral artery aneurysm which deviates across midline: A case report and review article

et al. 2019

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“…The head was fixed and flexed to avoid venous congestion and rotated to the side opposite to the site of the lesion using the stretching neck-shoulder angle, in which the ipsilateral mastoid body could be placed at the highest point for surgery. [2,3,5-7] An L-shaped skin incision was made from near the midline, 1 cm above the superior nuchal line (SNL), and the apex on the asterion, to near the C2 [Figure 2]. The lateral skin incision was extended to the tip of the mastoid process.…”

Section: Methodsmentioning

confidence: 99%

“…The OA was followed proximally to the inferior edge of the posterior belly of the digastric muscle. [2,3,5-7] The anatomic variations of the running pattern of the OA were identified around the LNG. The running pattern of the OA was classified into two types, running lateral or medial to the LNG.…”

Section: Methodsmentioning

confidence: 99%

“…The V3 segment is exposed in the suboccipital triangle, and the vertebral venous plexus is treated without inducing bleeding. [7] Finally, the rectus capitis posterior major and minor muscles were detached and retracted medially, and craniotomy could be performed. The full length of the dissected OA was retracted anteriorly from the scalp incision, and the integrity of the donor OA was kept intact until the recipient artery was completely prepared.…”

Section: Methodsmentioning

confidence: 99%

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Surgical microanatomy of the occipital artery for suboccipital muscle dissection and intracranial artery reconstruction

Hatano¹,

Ota²,

Noda³

et al. 2019

Surgical Neurology International

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Background: The occipital artery (OA) is an important donor artery for posterior fossa revascularization. Harvesting the OA is difficult in comparison to the superficial temporal artery because the OA runs between suboccipital muscles. Anatomical knowledge of the suboccipital muscles and OA is essential for harvesting the OA during elevation of the splenius capitis muscle (SPL) for reconstruction of the posterior inferior cerebellar artery. We analyzed the running pattern of the OA and its anatomic variations using preoperative and intraoperative findings. Methods: From April 2012 to March 2018, we surgically treated 162 patients with suboccipital muscle dissection by OA dissection using the lateral suboccipital approach. The running pattern and relationship between the suboccipital muscles and OA were retrospectively analyzed using the operation video and preoperative enhanced computed tomography (CT) images. The anatomic variation in the running pattern of the OA was classified into two types: lateral type, running lateral to the muscle and medial type, running medial to the longissimus capitis muscle (LNG). Results: The medial pattern was observed in 107 (66%) patients and the lateral pattern in 54 (33.3%); 1 (0.6%) patient had the OA running between the LNGs. Conclusion: Preoperative CT is effective in determining the running course of the OA, which is important for safely harvesting the OA during SPL elevation. There is a risk of causing OA injury in patients with the lateral pattern. This is the first report showing that the OA rarely runs in between the LNGs.

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“…Many vascular lesions in V3, including tumors, occlusions, deformities, and those caused by trauma, have been documented, and these lesions have been associated with dissection, aneurysm, and Bow Hunter Syndrome (1)(2)(3)(4)(5). The decision of whether to utilize or to protect V3 varies by the disease during treatment (6)(7)(8)(9)(10)(11)(12)(13). To date, many imaging modalities, such as digital subtraction angiography, dualenergy computed tomography, Doppler ultrasound, and MRI, have be applied to detect V3 (14)(15)(16)(17)(18).…”

Section: Introductionmentioning

confidence: 99%

The assessment of the frequency and arrangement of the subsegmental branches of V3 using computed tomography angiography

Liu

Song

et al. 2021

Quant Imaging Med Surg

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Background: The frequency and arrangement of the subsegmental branches of the third portion of the vertebral artery (V3) have been assessed in small samples by autopsy, but they have not been assessed by computed tomography angiography (CTA). To determine the frequency and arrangement of subsegmental branches of V3 by CTA and to analyze the interrelationships among frequency, arrangement, sex, and side-to-side.Methods: First, the radiology records of 668 consecutive patients who underwent cervical or craniocervical CTA scans from October 1, 2017 to October 31, 2019 were retrospectively retrieved. Second, the four demarcation points were ascertained to define the three subsegments by reviewing the resource images, namely, the vertical portion of V3(V3v), horizontal portion of V3(V3h), and extradural portion of V3(V3e).Then, the numerical value and the location of the bifurcating branch in each subsegment of V3 were recorded. Third, the frequency and arrangement of the branches was assessed, and the relationships between sex, laterality and frequency and arrangement were analyzed as well as the interobserver performance.Results: On the left, 25%, 20.21%, and 6.59% were the frequencies of one branch in the V3v, V3h, and V3e, and 1.05%, 0.00%, and 0.45% were the frequencies of two branches, respectively. On the right, 25.04%, 17.07%, and 6.44% were the frequencies of one branch in the V3v, V3h, and V3e, and 1.04%, 0.3%, and 0.15% were the frequencies of two branches, respectively. There were no differences between the side-to-side and numerical values of the branches according to the t-test (P=0.4341, P=0.7968), and there were no differences between the side-to-side variable, sex variable and number of branches according to the t-test (P=0.4474, P=0.3593). There were no differences between the side-to-side and eight arrangements (permutation of 000; 100; 110; 111; 010; 011; 001; 101) by using the two-sample KS test (P=0.942), and there were no differences between sex and the eight arrangements according to the two-sample KS test (P=0.9973, P=0.8519). The interobserver reliability was excellent (Spearman's ranked correlation: 0.9927). Conclusions:The frequency and arrangement of V3 subsegmental branches could be displayed by source imaging with CTA, and there were no significant differences according to the sex or side of the individual. It was imperative to acquaint the subsegmental branches before the operation involving V3 in the craniocervical junction to determine the surgical approach and reduce bleeding during the surgical procedures.

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A Contralateral Transcondylar Fossa Approach with Bilateral V3 Segment Exposure for Repairing Complex Vertebral Artery Aneurysms

Cited by 6 publications

References 28 publications

Contralateral transcondylar fossa approach with bilateral V3 segment exposure for clipping of vertebral artery aneurysm which deviates across midline: A case report and review article

Contralateral transcondylar fossa approach with bilateral V3 segment exposure for clipping of vertebral artery aneurysm which deviates across midline: A case report and review article

Surgical microanatomy of the occipital artery for suboccipital muscle dissection and intracranial artery reconstruction

The assessment of the frequency and arrangement of the subsegmental branches of V3 using computed tomography angiography

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