The microsurgical anatomy of the suboccipital vertebral artery and its surrounding structures

The suboccipital area contains the anatomic complex of the vertebral artery, its periarterial autonomic neural plexus, its branches, and the adjacent spinal nerves, all of which are cushioned in the venous compartment and covered by 3 layers of muscles. Until more recently, study of the microsurgical anatomy of this area has been neglected. Its thorough understanding provides, however, the foundation for surgical treatment of numerous pathologic entities in this area. Significant advances in understanding of the microsurgical anatomy have resulted in improved outcomes in the treatment of these entities, which now have become a routine. We review the microsurgical anatomy of the suboccipital area with its surgical and certain functional implications.