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Surgical anatomy of neurovascular structures related to ventral C1–2 complex: an anatomical study

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Abstract

Objective

Transoral odontoidectomy and ventral C1–2 stabilization are important surgical procedures, performed to decompress ventral spinal cord, and to stabilize craniovertebral junction. These procedures require knowledge regarding surgical anatomy of neurovascular structures ventral to the C1–2 complex. The aim of this study is to evaluate the relationships between neurovascular structures and bony landmarks in ventral atlantoaxial complex.

Materials and methods

This study was performed on six formaldehyde fixed cadaveric head and neck specimens. Relevant anatomical parameters, including distances from the midsagittal line to internal carotid arteries (ICA), vertebral arteries (VA), and hypoglossal nerves (HN), were measured using electronic calipers.

Results

The mean distance between ICA and midsagittal line was observed as 26.13 mm at the level of axis and 24.67 mm at the level of the atlas. The mean distance between VA and midsagittal line was observed as 15.38 mm at the level of axis and 26.54 mm at the level of the atlas. The mean distance between HN and midsagittal line was observed as 33.27 and 33.58 mm at the level of the atlas and axis, respectively.

Conclusion

This study confirmed that ICA and HN proceeded ventrally or laterally along the lateral aspect of the C1 lateral mass; therefore, the area located ventrally along the medial components of the C1 lateral mass was the safe zone for anterior surgical approach.

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References

  1. Beech TJ, McDermott AL, Kay AD et al (2012) Endoscopic endonasal resection of the odontoid peg—case report and literatüre review. Childs Nerv Syst 28:1795–1799

    Article  PubMed  Google Scholar 

  2. Wang C, Yan M, Zhou HT et al (2003) Treatment of irreducible atlantoaxial dislocation with surgical lysis through transoral approach and internal fixation by means of posterior approach (Chin). Zhongguo Ji Zhu Ji Sui Za Zhi 13:583–586

    Google Scholar 

  3. Kandziora F, Pflugmacher R, Ludwig K et al (2002) Biomechanical comparison of four anterior atlantoaxial plate systems. J Neurosurg 96(3):313–320

    PubMed  Google Scholar 

  4. Qiuhang Z, Feng K, Bo Y et al (2013) Transoral endoscopic odontoidectomy to decompress the cervicomedullary junction. Spine (Phila Pa 1976) 38:901–906

    Article  Google Scholar 

  5. Tubbs R, Shane et al (2016) Complications of transoral and transnasal odontoidectomy: a comprehensive review. Child’s Nerv Syst 32:55–59

    Article  Google Scholar 

  6. Kalb S, Reis MT, Cowperthwaite MC et al (2012) Dysphagia after anterior cervical spine surgery: incidence and risk factors. World Neurosurg 77(1):183–187

    Article  PubMed  Google Scholar 

  7. Stulík J, Vyskocil T, Sebesta P et al (2005) Harms technique of C1-C2 fixation with polyaxial screws and rods. [in Czech]. Acta Chir Orthop Traumatol Cech 72(1):22–27

    PubMed  Google Scholar 

  8. Ebraheim NA, Misson JR, Xu R, Yeasting RA (2000) The optimal transarticular c1–2 screw length and the location of the hypoglossal nerve. Surg Neurol 53(3):208–210

    Article  CAS  PubMed  Google Scholar 

  9. Janfaza P, Nadol JB, Galla RJ et al (2001) Surgical anatomy of the head and neck. Lippincott, Williams and Wilkins, Philadelphia, p 575

    Google Scholar 

  10. Hoh DJ, Maya M, Jung A et al (2008) Anatomical relationship of the internal carotid artery to C-1: clinical implications for screw fixation of the atlas. J Neurosurg Spine 8:335–340

    Article  PubMed  Google Scholar 

  11. Currier BL, Todd LT, Maus TP et al (2003) Anatomic relationship of the internal carotid artery to the C1 vertebra: a case report of cervical reconstruction for chordoma and pilot study to assess the risk of screw fixation of the atlas. Spine 28(22):461–467

    Article  Google Scholar 

  12. Currier BL, Maus TP, Eck JC et al (2008) Relationship of the internal carotid artery to the anterior aspect of the C1 vertebra implications for C1–C2 transarticular and C1 lateral mass fixation. Spine 33(6):635–639

    Article  PubMed  Google Scholar 

  13. Estillore RP, Buchowski JM, Minh DV et al (2011) Risk of internal carotid artery injury during C1 screw placement: analysis of 160 computed tomography angiograms. Spine J 11:316–323

    Article  PubMed  Google Scholar 

  14. Murakami S, Mizutani J, Fukuoka M et al (2008) Relationship between screw trajectory of C1 lateral mass screw and internal carotid artery. Spine 33(24):2581–2585

    Article  PubMed  Google Scholar 

  15. Şimşek S, Yiğitkanlı K, Turba UC et al (2009) Safe zone For C1 lateral mass screw: anatomic and radiological study. Neurosurgery 65:1154–1160

    Article  PubMed  Google Scholar 

  16. Cho SK, Lu Y, Lee DH (2013) Dysphagia following anterior cervical spinal surgery: a systematic review. Bone Joint J 95-B (7):868–873

    Article  CAS  PubMed  Google Scholar 

  17. Lee MJ, Bazaz R, Furey CG et al (2007) Risk factors for dysphagia after anterior cervical spine surgery: a two-year prospective cohort study. Spine J 7:141–147

    Article  PubMed  Google Scholar 

  18. Rihn JA, Kane J, Albert TJ et al (2011) What is the incidence and severity of dysphagia after anterior cervical surgery? Clin Orthop Relat Res 469:658–665

    Article  PubMed  Google Scholar 

  19. Hong JT, Lee SW, Son BC et al (2006) Hypoglossal nerve palsy after posterior screw placement on the C-1 lateral mass. J Neurosurg Spine 5:83–85

    Article  PubMed  Google Scholar 

  20. Peng CW, Chou BT, Bendo JA, Spivak JM (2009) Vertebral artery injury in cervical spine surgery: anatomical considerations, management, and preventive measures. Spine J 9:70–76

    Article  PubMed  Google Scholar 

  21. Sardhara J, Behari S, Mohan BM et al (2015) Risk stratification of vertebral artery vulnerability during surgery for congenital atlanto-axial dislocation with or without an occipitalized atlas. Neurol India 63(3):382–391

    Article  PubMed  Google Scholar 

  22. Crockard HA, Pozo JL, Ransford AO et al (1986) Transoral decompression and posterior fusion for rheumatoid atlanto-axial subluxation. J Bone Joint Surg 68B(3):350–356

    Article  Google Scholar 

  23. Dickman CA, Spetzler RF, Sonntag VKH, Apostolides PJ (2013) Transoral approach to the craniovertebral junction. In: Dickman CA, Spetzler RF, Sonntag VKH (eds) Surgery of the craniovertebral junction. Thieme, New York, pp 277–290

    Google Scholar 

  24. Scalici E, Indorato F, Portelli F et al (2014) A fatal iatrogenic right vertebral injury after transoral odontoidectomy and posterior cervical stabilization for a type II odontoid fracture. J Forensic Leg Med 22:41–44

    Article  PubMed  Google Scholar 

  25. Duan S, He H, Lv S, Chen L (2010) Three-dimensional CT study on the anatomy of vertebral artery at atlantoaxial and intracranial segment. Surg Radiol Anat 32(1):39–44

    Article  PubMed  Google Scholar 

  26. Ai F, Yin Q, Wang Z, Xia H et al (2006) Applied anatomy of transoral atlantoaxial reduction plate internal fixation. Spine 31(2):128–132

    Article  PubMed  Google Scholar 

  27. Hu Y, Yang S, Xie H et al (2008) The anatomic study on replacement of artificial atlanto-odontoid joint through transoral approach. J Huazhong Univ Sci Technol Med Sci 28(3):327–332

    Article  PubMed  Google Scholar 

  28. Lu B, He XJ, Zhao CG et al (2009) Artificial atlanto-odontoid joint replacement through a transoral approach. Eur Spine J 18(1):109–117

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Anatomy, School of Medicine, Dokuz Eylül University, 35340, Balçova, Izmir, Turkey

    Sibel Cirpan, Salih Sayhan, Goksin Nilufer Yonguc, Canan Eyuboglu & Mustafa Güvençer

  2. Clinics of Neurosurgery, Ege Private Hospital, Denizli, Turkey

    Salih Sayhan

  3. Department of Neurosurgery, Health Sciences University, Ümraniye Education and Research Hospital, Istanbul, Turkey

    Sait Naderi

Authors
  1. Sibel Cirpan
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  2. Salih Sayhan
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  3. Goksin Nilufer Yonguc
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  4. Canan Eyuboglu
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  5. Mustafa Güvençer
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  6. Sait Naderi
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Correspondence to Mustafa Güvençer.

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Cirpan, S., Sayhan, S., Yonguc, G.N. et al. Surgical anatomy of neurovascular structures related to ventral C1–2 complex: an anatomical study. Surg Radiol Anat 40, 581–586 (2018). https://doi.org/10.1007/s00276-017-1961-5

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  • DOI: https://doi.org/10.1007/s00276-017-1961-5

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