A narrative review of techniques for surgical revascularization of the extracranial vertebral artery in vertebrobasilar insufficiency

Vertebrobasilar insufficiency is a condition characterized by poor blood flow through the posterior circulation of the brain, which supplies the brainstem, thalamus, hippocampus, cerebellum, occipital lobes, and medial temporal lobes. Narrowing or occlusion of the vertebral arteries may be result in a range of neurological symptoms, including dizziness, imbalance, dysarthria, and even stroke. If symptomatic patients fail medical management, revascularization of the vertebral artery should be considered. Restoration of blood flow may involve transluminal balloon angioplasty or stent placement; however, certain cases may still require surgical intervention. The complexity of surgical revascularization of the vertebral artery requires careful consideration of skull base and neck anatomy. This review article will focus on bypass of the vertebral artery in the setting of ischemic pathology, describing the technique, anatomical nuances, steps involved in preoperative planning, and postoperative management.