title: Landmarks for vertebral artery repositioning in bulbar compression syndrome: anatomic and microsurgical nuances.
abstract: OBJECTIVE
  The purpose of this study was to better elucidate the anatomic relationship between the vertebral artery (VA) along with its perforating vessels and the brainstem to develop anatomic guidelines that would be helpful when decompressing medulla oblongata compressed by the VA.
  
  
  METHODS
  Microanatomy dissection was performed in six formalin-fixed cadaveric heads. The VA, posteroinferior cerebellar artery (PICA), anteroinferior cerebellar artery (AICA), and lower brainstem perforators were examined under magnification using a surgical microscope. The outer diameters of the VA, PICA, and AICA were measured. The distance between the VA, lying within the lateral cerebellomedullary cistern, and the medulla oblongata was quantified. The lower brainstem perforating vessels were examined in relation to their course, outer diameter, and length.
  
  
  RESULTS
  In four of six brains, the left VA was dominant, presenting an outer diameter at least 0.8 mm larger than the contralateral VA. The average distance between the VA and the medulla oblongata was 3 mm. The perforating branches presented a mean outer diameter of 0.7 mm. In particular, perforators arising from the VA and PICA (Groups 1 and 2) presented an average outer diameter of 0.2 mm and an average length of 7 mm. Perforating vessels arising from the AICA and vertebrobasilar junction (Groups 3 and 4) presented an average outer diameter of 0.4 mm and an average length of 12 mm.
  
  
  CONCLUSIONS
  This work provides new information that may be useful to minimize the risk of injury of perforators when operating on medulla oblongata compression by the VA.
authors.affiliation: Department of Neurosurgery, University of Messina, Messina, Italy. Giovanni.Grasso@unime.it
authors.forename: Giovanni
authors.initials: G
authors.lastname: Grasso
authors.forename: Concetta
authors.initials: C
authors.lastname: Alafaci
authors.forename: Marcello
authors.initials: M
authors.lastname: Passalacqua
authors.forename: Manfred
authors.initials: M
authors.lastname: Tschabitscher
authors.forename: Francesco M
authors.initials: FM
authors.lastname: Salpietro
authors.forename: Francesco
authors.initials: F
authors.lastname: Tomasello
mesh_terms: D001933:Brain Stem / Q000473:pathology / Q000601:surgery; D006801:Humans; D008526:Medulla Oblongata / Q000473:pathology* / Q000601:surgery*; D008866:Microsurgery / Q000379:methods*; D017410:Practice Guidelines as Topic; D013577:Syndrome; D014711:Vertebral Artery / Q000033:anatomy & histology* / Q000473:pathology / Q000601:surgery*