THE ANTERIOR OPERATIVE APPROACH TO THE CERVICAL VERTEBRAL ARTERY

BACKGROUND: Vertebral arterial trauma continues to be a perplexing dia gnostic and therapeutic challenge, Operative management is often requi red despite improved radiologic interventions for these injuries, Acco unts of the operative approaches to anterior cervical vertebral artery injuries have been limited, STUDY DESIGN: We reviewed our experience with anterior cervical vertebral arterial trauma in 53 consecutive pat ients requiring operative management during a 14-year period, in seven patients, the vertebral arterial injury was identified at urgent surg ical intervention either for an expanded cervical hematoma or active b leeding, The remaining injuries were identified by arteriographic inve stigation of penetrating cervical trauma, The injuries were equally di stributed between the three anatomic zones of the anterior cervical ve rtebral artery, The general features of the operative approaches that were used to manage these injuries were the emphasis of the study, RES ULTS: The anterior approaches to patients with vertical arterial traum a were effective in controlling injuries in all cases, Proximal and di stal ligation of the artery adjacent to the injury site was accomplish ed in 95 percent of the patients, Associated major cervical injuries i n 43 percent of the patients (carotid artery, eight patients; pharyngo esophageal, six patients; and neurologic, nine patients) contributed t o the postoperative morbidity rate and the overall mortality rate of 1 0 percent, CONCLUSIONS: The surgeon approaching vertebral arterial tra uma should have a clear appreciation of the deep anterior cervical ana tomy to expedite the operative management and avoid unnecessary compli cations related to a misdirected surgical dissection, The descriptions of the operative techniques used in this clinical experience can aid the surgeon in managing patients with vertebral vascular trauma.