Abstract
Precise surgical technique permits exposure of any part of the vertebral artery (VA) without problems. The lateral approach is the most reliable technique and can be applied at any level. At the third segment level, another option is the posterolateral approach, Generally, the field between the sterno-mastoid muscle and the internal jugular vein is opened. Then the prevertebral muscles are divided to expose the transverse processes. At the V2 and V3 segments, it is important to work out of the periosteal sheath surrounding the VA and its venous plexus. This article describes the particular technical points for each VA segment and potential complications. The main causes of morbidity are the leakage of lymph in the first segment, Horner's syndrome in the second segment, and accessory nerve (CN XI) pain or palsy in the third segment. Also discussed are various extensions of the lateral approach from the VA exposure at each level.
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