Department of Neurosurgery, Japanese Red Cross Asahikawa Hospital, 1-1-1-1, Akebono, Asahikawa, Hokkaido, 070-8530, Japan.
Institute of Molecular and Translational Medicine, Faculty of Medicine and Dentistry, Palacky University and Faculty Hospital Olomouc, Hněvotínská 1333/5, 779 00, Olomouc, Czech Republic.
Neurosurg Rev. 2019 Dec;42(4):991-997. doi: 10.1007/s10143-019-01158-5. Epub 2019 Aug 13.
Craniovertebral junction surgery usually requires the exposure of the third segment of the vertebral artery (V3). However, the complexity of musculature, a relatively high incidence of anomalies in the course of the vertebral artery (VA), and the presence of a rich venous plexus in this region make the V3 exposure challenging with a high risk of serious complications while taking down the suboccipital muscles in a single layer. A muscle dissection in interfascial layers, however, overcomes the drawbacks inherent in a blind dissection of the V3 as each of the muscles represents substantial landmark aiding subsequent step of the procedure and thus helping identify underlying anatomical structure early and safely. Moreover, along with a bloodless VA dissection off its surrounding venous plexus, it permits a safe and comfortable V3 exposure during the surgically demanding procedures.
颅颈交界区手术通常需要显露椎动脉第三段（V3）。然而，由于该区域肌肉结构复杂，椎动脉走行异常的发生率相对较高，且静脉丛丰富，因此在单层切除枕下肌群时，V3 的显露具有挑战性，严重并发症的风险较高。然而，在筋膜间进行肌肉解剖可以克服 V3 盲目解剖所固有的缺陷，因为每块肌肉都是重要的解剖标志，有助于后续步骤，并能早期、安全地识别潜在的解剖结构。此外，V3 周围静脉丛的无血椎动脉解剖，也允许在手术要求较高的过程中安全舒适地显露 V3。
