Exposure of the V1 Segment of the Vertebral Artery: Stepwise Cadaveric Surgical Simulation

BACKGROUND: Surgical exposure of the V1 segment of the vertebral artery (V1-VA) at the lower neck may be necessary to address intravascular (atherosclerotic) and extravascular (external compression by neoplastic or degenerative) pathologies. The adjacent anatomy at the lower cervical region is complex and relatively unfamiliar to neurosurgeons compared to that of upper cervical levels. High-quality cadaveric images simulating the surgical approach to V1-VA are important for learning the relevant anatomy. OBJECTIVE: To provide a brief stepwise depiction of the exposure of the V1-VA using a cadaveric surgical simulation. METHODS: A cadaveric surgical simulation was performed on the left side to expose the V1-VA using the retrojugular and interjugular carotid approaches. The important adjacent anatomic structures en route to the V1-VA were identified. RESULTS: A stepwise photographic demonstration of the surgical exposure of the V1-VA is provided. CONCLUSION: Exposure of the V1-VA can be challenging and requires a clear anatomic understanding of the relevant anatomy. The present work attempts to facilitate this objective.