George B, Laurian C, Derome P, Guilmet D
Neurochirurgie. 1979;25(2):124-8.
A reappraisal of surgical possibilities on the third portion of the Vertebral Artery (V.A.) above C2, have been done from an anatomical study on 20 autopsied specimen. A route passing between the Internal Jugular Vein and the Sternocleido-mastoidian muscle allows a rather simple approach of the transverse process of C1. After dividing two muscles taking insertion on this process, 1,5 cm of the V.A. can be exposed. For larger exposure of the artery, the Foramen Transversaris of C1 must be unroofed and the artery dissected in the guttering of the posterior arch of Atlas. This surgical route was used in a case of aneurismal dysplasia at C3 level. An anastomosis between Subclavian Artery and V.A. at C1-C2 level was realized with an autologous saphenous vein graft. The keypoints are the highest possible freeing of the XI nerve and the head position. Rotation and extension move the transverse process and the posterior arch of Atlas superficially and anteriorly.
通过对20个尸检标本的解剖学研究，对C2以上椎动脉（V.A.）第三部分的手术可能性进行了重新评估。一条经过颈内静脉和胸锁乳突肌之间的路径可实现对C1横突的相对简单的显露。在切断附着于该横突的两块肌肉后，可暴露1.5厘米的椎动脉。为了更大程度地暴露动脉，必须打开C1的横突孔，并在寰椎后弓的沟内解剖动脉。该手术路径用于一例C3水平的动脉瘤样发育异常病例。使用自体大隐静脉移植物在C1-C2水平实现了锁骨下动脉与椎动脉的吻合。关键要点是尽可能高地游离XI神经和头部位置。旋转和伸展可使寰椎的横突和后弓浅表地向前移动。
