Anterior vertebral artery mobilization

Abstract

Indication for mobilization of the VA depends on pathologies: simple displacement of the VA to approach a lesion or access of the VA enabling a vascular procedure. The normal anatomy and its variation as abnormal way secondary to lesion must be known before surgery, helped by classical and angio-images. Mobilization of the C2-C0 portion of VA is described in this chapter: the approach is retro-vascular, going between the jugular vein frontwards and the deep part of the sternocleidomastoid muscle backwards. (The spinal accessory nerve must be identified.) Transverse processes of C1 and C2 are palpated and dissected subperiosteally, and the bone is slowly resected allowing to expose the VA and its mobilization. If necessary the VA can be followed cranially and caudally.