VA: Vertebral Artery

Picture
Medial medullary / Dejerine
Lateral medullary / Wallenberg
Vertebral artery dissection: if completely occluded, risk for recanalization with emboli -> tx with sacrifice of artery vs. anti platelet. 
Vertebral artery stenosis: 
Stellate Block
Subclavian Steal
V4
(Intradural)
V4 ANEURYSM
  • Dx: balloon occlusion test (if tolerate --> occlude parent vessel). If not, stent +/- bypass with high morbidity/mortality 
V3 
(C2-Dura)
  • Course: from C1 transverse foramen through dura
    • Passes behind C1 SAP (medial/posterior), across groove on upper surface of posterior arch
    • Courses beneath atlato-occipital membrane, superior to vertebral canal
    • Covered by Semispinalis capitis in Suboccipital Triangle (bounded by Superior oblique, Inferior oblique, Rectus capitus posterior major) 
BOW-HUNTER'S SYNDROME
Loc: dominant VA @ C1-C2
MoA: head rotation --> mechanical compression of VA (2-2 bone spurs, fibrous bands, etc) --> vertebrobasilar insufficiency
V2
(Foraminal)
  • Course: through C6-2 transverse foramen
    • Surrounded by inferior cervical sympathetic ganglion and venous plexus of vertebral vein
V1
(Pre-foraminal)
  • Course: subclavian -> C6 TP
    • Runs superiorly and posteriorly between Longus coli and Anterior Scalenes, anterior to C7 TP, sympathetic trunk/inferior cervical ganglion
    • Left VA is crossed by thoracic duct
References: Jahromi BS, Mocco J, Bang JA, Gologorsky Y, Siddiqui AH, Horowitz MB, Hopkins LN, Levy EI: Clinical and angiographic outcome after endovascular management of giant intracranial aneurysms. Neurosurgery 63, 2008.