Vertebral Artery Surgery – An Overview of Techniques and Discussion Points for the Future

The vertebral artery (VA) is an important vessel supplying the hind brain; its surgical exposure and control is usually considered a great challenge. In fact, with good knowledge of surgical anatomy and proper surgical technique, the VA can be controlled and occasionally repaired with safety and reliability. VA exposure is useful in many instances and helps attain better results in the surgical treatment of many different pathologies at any level all along its course in the neck and the skull. These pathologies include intrinsic lesions (atherosclerosis, aneurysms, arteriovenous fistulas), intermittent compression by osteophytes or fibrous bands, and permanent compression mostly by different types of tumours. VA exposure also helps to achieve better treatment of spondylotic myelopathy (by oblique corpectomy) and of tumours at the craniocervical junction, foramen magnum and jugular foramen level. Based on the experience of more than 1,600 surgical approaches, VA surgery is associated with a very limited morbidity and mortality.