| Objective: We performed a microanatomical study of craniocervical junction(CCJ) segment of the vertebral artery(VA) in healthy adult cadaveric heads specimens with the aid of surgical microscope to provide anatomic datas and clinic informations for craniocervical junction; It would be help clinicians to exposure the surgical target safety and accurately by simulated the suboccipiatal far lateral approach, as well as reduce complications.Methods:1 Rinse clean the vessel of ten healthy adult cadaveric heads specimens were fixed in formaldehyde and then injected with red(arteries) and blue(veins) latex. After that those specimens were simulated operation of the suboccipiatal far later approach with the aid of surgical microscope. Particular attention was given to the course and type of muscles, vessels and nerves, as well as the osseous relationships in the region. Observed and token photos of those structure.2 The measurements included curvature diameters and angles of craniocervical junction segment of the vertebral artery, midpoint of posterior border of foramen magnum to the position where the vertebral artery goes through the dura mater, the inner edge of occipital condyle to the position where the vertebral artery goes through the dura mater, the inner diameter of transverse process of the atlas, the inner diameter of transverse process of the axial, the diameter of occipital condyle, the transverse diameter of occipital condyle, the inner edge of hypoglossal canal to the poster edge of occipital condyle, the outer edge of hypoglossal canal to the poster edge of occipital condyle.1 Most of the occipital arteries run in the occipital groove between the longissimus capitis muscle and the superior oblique muscle; Others cross between the cervical deep fascia and the longissimus capitis muscle; 2 The vertebral artery will course deep to the suboccipital triangle, which are consist of the rectus capitis posterior major muscle, the superior oblique muscle, and the inferior oblique muscle; 3 The vertebral artery, after passing through the transverse process of the atlas, turns medially behind the atlanto-occipital joint and is pressed into the groove on the upper surface of the lateral part of the posterior arch of the atlas, where it courses along the floor of the suboccipital triangle. It is surrounded by rich of venous plexus; 4 There are rich of venous plexus in the suboccipital triangle, its course and irregular, more and more intensive from passing through the transverse process of the atlas to the position where the vertebral artery goes through the dura mater; 5 Craniocervical junction segment of the vertebral artery has six curvatures in most of the specimens, its course and irregular with changeful direction, First curvature diameter, Left(4.20 ±0.56) mm, Right(4.16±0.44) mm, Average(4.18±0.50) mm; Angle, Left(91±23) degrees, Right(89±21) degrees, Average(90±22) degrees; Second curvature diameter, Left(4.50±0.42) mm, Right(4.32±0.52) mm, Average(4.41±0.50) mm; Angle, Left(108±29) degrees, Right(112±26) degrees, Average(110±27) degrees; Third curvature diameter, Left(4.36±0.42) mm, Right(4.24±0.64) mm, Average(4.30±0.52) mm; Angle, Left(146±20) degrees, Right(152±18) degrees, average(150±19) degrees; Fourth curvature diameter, Left(4.10±0.40) mm, Right(3.92±0.38) mm, Average(4.02±0.40) mm; Angle Left(86±23) degrees, Right(91±25) degrees, Average(89±24) degrees; Fifth curvature diameter, Left(4.56±0.52) mm, Right(4.28±0.66) mm, Average(4.40±0.54) mm; Angle, Left(132±22) degrees, Right(128±24) degrees, Average(131±25) degrees; Sixth curvature diameter, Left(4.32±0.46) mm, Right(4.18±0.56) mm, Average(4.22±0.50) mm; Angle, Left(117±27) degrees, Right(126±21) degrees, Average(119±24) degrees; 6 The distance from midpoint of posterior border of foramen magnum to the position where the vertebral artery goes through the dura mater, Results: Left(20.55±2.05) mm, Right(21.60±2.10) mm, Average(21.35±2.15) mm; 7 The inner diameter of transverse process of the atlas, Left(6.85±1.16) mm, Right side of(7.12±0.90) mm, Average(7.02±1.12) mm. the inner diameter of transverse process of the axial, Left(6.35±0.56) mm, Right(5.98±0.46) mm, Average(6.23±0.52) mm; 8 The diameter of occipital condyle, Left(23.10±1.58) mm, Right(22.38±2.28) mm, Average(22.80±1.60) mm; The transverse diameter of occipital condyle, Left(13.22±1.02) mm, Right(12.44±0.98) mm, Average(12.89±1.01) mm; 9 The inner edge of occipital condyle to the position where the vertebral artery goes through the dura mater, Left(10.07±1.17) mm, Right(10.41±1.66) mm, Average(10.22±1.56) mm; 10 From the inner edge of hypoglossal canal to the poster edge of occipital condyle, Left(5.10±0.32)mm, Right(4.65±0.54)mm, Average(4.92±0.46) mm; From the outer edge of hypoglossal canal to the poster edge of occipital condyle, Left(13.24±3.61) mm, Right(13.39±3.45) mm, Average(13.32±3.52) mm.Conclusion:1 Detailed knowledge of craniocervical junction(CCJ) segment of the vertebral artery(VA) is helpful on operation of the suboccipiatal far later approach, reduce complications.2 Suboccipital triangle, transverse process of the atlas, venous plexus, and the C1 nerve and the C1 nerve are important symbol of craniocervical junction(CCJ) segment of the vertebral artery in the suboccipiatal far later approach, From outside to inside dissociated the vertebral artery could avoid damage to its branch.3 Craniocervical junction segment of the vertebral artery running tortuous, with changeful direction, could adapt to the complex head and neck movements, but also increases the risk of surgery on craniocervical junction, Knowledge and understanding of craniocervical junction segment of the vertebral artery could avoid damage to the vertebral artery and its branch.4 Observed and token photos of the soft tissues of craniocervical junction(CCJ) to provide an applied anatomic data and clinic information for protect to the vertebral artery and its branch. |
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