Key result
C1 transversectomy increases surgical working area ~130% compared with standard exposure.
Why the study?
The occipital artery-vertebral artery (OA-VA) bypass of the V3 segment is a possible revascularization strategy through the anterolateral approach, but the impact of C1 transverse process removal on surgical corridor expansion, VA mobility, and microsurgical ergonomics had not been evaluated.
Does C1 transversectomy and vertebral artery skeletonization improve surgical working area, exposed vertebral artery length, mobility, and microsurgical ergonomics compared to standard anterolateral exposure in cadaveric specimens?
Does C1 transversectomy and vertebral artery skeletonization improve surgical working area, exposed vertebral artery length, mobility, and microsurgical ergonomics compared to standard anterolateral exposure in cadaveric specimens?
In a cadaveric model, C1 transversectomy significantly increases surgical working area, vertebral artery exposure and mobility, and instrument divergence angle within the anterolateral occipital artery–V3 bypass corridor without changing working depth.
Answers are grounded in this paper and cite their sources.
May facilitate OA-V3 bypass access in cadaveric models; leaves open clinical translation and safety.
BACKGROUND AND OBJECTIVES: The occipital artery–vertebral artery (OA–VA) bypass of the V3 segment has been described as a possible feasible revascularization strategy through the anterolateral approach. However, the impact of C1 transverse process removal on surgical corridor expansion, VA mobility, and microsurgical ergonomics has not been evaluated. In this cadaveric study, we assessed the anatomic and ergonomic effect of C1 transversectomy for OA–V3 bypass. METHODS: Five injected cadaveric specimens (10 sides) were subjected to paired analysis comparing standard anterolateral exposure (baseline) vs the same approach with C1 transversectomy and VA skeletonization. Quantitative end points included surgical working area, exposed VA length, working depth, and instrument divergence angle. Paired statistical analysis was calculated. RESULTS: C1 transversectomy resulted in a significant improvement in all major parameters of surgical exposure. The working area increased by 130% (from 226.1 to 519.1 mm 2 , P < .001), whereas the exposed VA length increased by 84% (from 12.7 to 23.4 mm, P = .002). VA mobility demonstrated the greatest relative gain, increasing by 207% (from 1.5 to 4.6 mm, P < .001). The instrument divergence angle also significantly improved, increasing by 109% (from 18.2° to 38.1°, P < .001). No statistically significant changes were observed in working depth. CONCLUSION: C1 transversectomy markedly enhances exposure, mobility, and operative ergonomics within the anterolateral OA–V3 corridor. These findings provide quantitative anatomic validation of a technical refinement that may improve reproducibility and safety of OA–VA bypass in selected clinical scenarios.
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Dolci et al. (2026) studied Occipital artery–vertebral artery (OA–VA) bypass of the V3 segment (cadaveric model) (n=5). Anterolateral exposure with C1 transversectomy and vertebral artery (VA) skeletonization vs. Standard anterolateral exposure (baseline) was evaluated on Surgical working area, exposed VA length, VA mobility, working depth, and instrument divergence angle (p=<0.001). C1 transversectomy increased surgical working area by 130% (226.1 to 519.1 mm², P<.001) and VA mobility by 207% (1.5 to 4.6 mm, P<.001) vs standard exposure.
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