Accessory Vertebral Artery: An Embryological Review With Translation from Adachi

Stephen J Bordes,Joe Iwanaga,R Shane Tubbs,Koichi Watanabe,Sina Zarrintan

doi:10.7759/cureus.13448

Abstract

The vertebral arteries arise from the posterior superior aspect of the bilateral subclavian arteries and course superiorly through the transverse foramina of C1-C6 vertebrae before joining one another along the anterior surface of the pons. Developmental variations during the fourth to sixth weeks of embryonic development may result in the formation of accessory vertebral arteries, i.e., ipsilateral vertebral arteries of dual origin. This anatomical variation is distinct from and often confused with vertebral artery duplications and fenestrations. This article reviews the anatomy and embryology of the accessory vertebral artery with excerpts from Buntaro Adachi’s classic text on vascular anatomical variations. Knowledge of accessory vertebral vessels is important during vascular and spinal procedures of the head and neck. Furthermore, these variations have been associated with cerebrovascular pathologies, such as stroke, dissection, and other hemodynamic anomalies.

Highlights

BackgroundThe vertebral arteries commonly originate as the first and largest branches of the left and right subclavian arteries [1,2,3,4]
The arteries give off various branches and fuse together, forming the basilar artery anterior to the pons, after passing through the posterior atlantooccipital membrane, dura mater, and foramen magnum [1,2]
We provide a translation of Adachi’s “Rudiment of the Common Vertebral Artery,” discuss the embryological origins of the accessory vertebral artery, and compare this accessory vessel with vertebral artery duplications and fenestrations in order to clarify these terminologies

Summary

Introduction

The vertebral arteries commonly originate as the first and largest branches of the left and right subclavian arteries [1,2,3,4]. Adachi mentioned that the accessory vessel typically exists in the presence of a left main vertebral artery that originates from the aortic arch [8]. It is believed that persistence of the distal segment of the fifth or sixth intersegmental artery leads to the origination of one or both vertebral arteries from the aortic arch as opposed to their respective subclavian artery [22]. As highlighted by Adachi, surgeons should be alerted to the possibility of an accessory vertebral artery in the presence of a vertebral artery of aortic arch origin (Figure 13)

Conclusions

Disclosures

Yuan SM

Adachi B: Anatomie Der Japaner 1

Findings

11. Suzuki S