Our common interest in surgery of the vertebral artery was born in 1976, when as residents in the same hospital, we attended an attempt by two senior surgeons to treat an aneurysm of the vertebral artery at the C 3 level. Long discussions had preceded this unsuccessful trial, to decide if surgery was indicated and to choose the surgical route. Finally a direct lateral approach was performed, but access was difficult and correct treatment was impossible, resulting in only partial reduction of the aneurysmal pouch. Following this experience, we decided to seek a regular and well defined approach for exposition of the vertebral artery. Review of the literature indicated some surgical attempts, but the descriptions did not give the impression of safety and reproducibility. No landmark on the described surgical route appeared sufficiently reliable. Henry's anatomical work (1917) gave the only accurate description on vertebral artery anatomy, and it became the basis for our work. When the same patient was referred again one year later, after a new stroke in the vertebro-basilar system, we had behind us repetitive experience on cadavers of an original approach to the distal vertebral artery.
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Dateigröße
ISBN-13
978-3-7091-6967-4 (9783709169674)
DOI
10.1007/978-3-7091-6967-4
Schweitzer Klassifikation
1. Introduction.- 2. Anatomy.- 2.1. Introduction.- 2.2. Embryology.- 2.3. Structure.- 2.4. Description.- 2.5. Relation to Vascular and Nervous Structures.- 2.6. Branches.- 3. Congenital Abnormalities.- 3.1. Duplication.- 3.2. Tortuosity and Kinking.- 3.3. Persistent Primitive Arteries.- 3.4. Branches.- 4. Wall Lesions.- 4.1. Atherosclerosis.- 4.2. Dissection.- 4.3. Fibromuscular Dysplasia.- 4.4. Unusual Lesions of the V.A..- 5. Arteriovenous Malformations.- 5.1. Spontaneous Vertebro-vertebral Fistulas.- 5.2. Traumatic Arteriovenous Fistulas.- 5.3. Congenital Regional Arteriovenous Malformation or Angiodysplasia.- 6. Tumor.- 6.1. Introduction.- 6.2. Relation to the V.A..- 6.3. Location of Tumors Involving the V.A..- 6.4. External Compression.- 6.5. Histology of Tumors Involving the V.A..- 7. External Compression.- 7.1. Second Portion.- 7.2. First Portion.- 7.3. Third Portion.- 8. Trauma.- 8.1. Modality.- 8.2. Mechanism.- 8.3. Level of Injury.- 8.4. Onset of Symptoms.- 9. Infancy and Childhood.- 9.1. Traumatic Lesions in the Newborn.- 9.2. Traumatic Lesions in Childhood.- 9.3. Congenital Arteriovenous Fistula.- 10. Pathophysiology.- 10.1. V. A. Preservation.- 10.2. Prevention of Ischemic Events.- 11. Pre-operative Investigations.- 11.1. Morphologic Exams.- 11.2. Functional Examinations.- 11.3. Interventional Radiology.- 11.4. Management of Pre-operative Investigations.- 12. Approach to the Cervical V. A..- 12.1. Historical Background.- 12.2. General Principles.- 12.3. Surgical Routes.- 12.4. Discussion of Surgical Approaches.- 12.5. Surgical Competence.- 13. Techniques of V. A. Surgery.- 13.1. Introduction.- 13.2. Wall Lesions.- 13.3. Arteriovenous Malformations.- 13.4. Tumor.- 13.5. External Compression.- 13.6. Intraoperative Embolization.- 14. Personal Experience.- 14.1. Wall Lesions.- 14.2. Distal Revascularization.- 14.3. Arteriovenous Malformations.- 14.4. Tumor.- 14.5. External Compression.- 14.6. Trauma.- 14.7. V. A. Surgery and Interventional Radiology.- 15. Conclusion.- References.
