Tumors involving the VA and cervical spine are surgically challenging and require a repertory of specialized strategies.

Topographic relationships of VA’s complex and variable anatomy can be modified by tumors.

Proper surgical exposure of the VA maximizes tumor resection while minimizing morbidity.

Sufficient collateral flow must be documented before occluding a VA, even if it is most of the time well tolerated.

A VA injury may lead to delayed complications and require appropriate follow-up.

The vertebral artery (VA) is in close proximity to bony structures, nerves and nerve sheaths of the cervical spine and craniovertebral junction (CVJ). These structures can be sources of tumors that are responsible for displacement, encasement and sometimes invasion of the VA. Removing these tumors while minimizing the risk of vascular injury requires thorough knowledge of the vascular anatomy, risk factors of vascular injury, the relationships of each tumor type with the VA, and the different surgical approaches and techniques that result in the best outcomes in terms of vascular control, tumoral exposure and resection.

To present an overview of preoperative and anatomical considerations, differential diagnoses and various approaches to consider in cases of tumors in close relationship with the VA.

A review of recent literature was conducted to examine the anatomy of the VA, the tumors most frequently affecting it, surgical approaches, and the necessary pre-operative preparations for ensuring safe and maximal tumor resection. This review aims to underscore the principles of treatment.

Tumors located at the CVJ and the cervical spine intimately involved with the VA, pose a surgical challenge and increase the risk of incomplete removal of the lesion. Detailed knowledge of the patient-specific anatomy and a targeted pre-operative work-up enable optimal planning of surgical approach and management of the VA, thereby reducing surgical risks and improving extent of resection.

anterolateral approach

anterior spinal artery

balloon test occlusion

craniovertebral junction

foramen magnum meningioma

intra-tumoral resection

postero-inferior cerebellar artery

progression free survival

(malignant) peripheral nerve sheath tumor

neurofibromatosis type 1-2

posterior spinal artery

primitive neuro ectrodermal tumor

vertebral artery injury

V1 to V4 segments of the vertebral artery

Vertebral artery

Tumor

Encasement

Craniovertebral junction

Cervical spine

© 2024 The Author(s). Published by Elsevier Masson SAS.