{"id":5509,"date":"2023-02-20T20:46:36","date_gmt":"2023-02-20T20:46:36","guid":{"rendered":"https:\/\/www.karotidnahirurgija.com\/?page_id=5509"},"modified":"2023-02-24T10:41:37","modified_gmt":"2023-02-24T10:41:37","slug":"26-1-eksponiranje-vertebralne-arterije-u-kostenom-kanalu-v2","status":"publish","type":"page","link":"https:\/\/www.karotidnahirurgija.com\/?page_id=5509","title":{"rendered":"26. 1. EKSPONIRANJE VERTEBRALNE ARTERIJE U KO\u0160TENOM KANALU (V2)."},"content":{"rendered":"

\"\"<\/a><\/p>\n

<\/p>\n

INDIKACIJE ZA REKONSTRUKCIJU
VERTEBRALNE ARTERIJE<\/h1>\n

<\/a><\/h1>\n

<\/p>\n

26.1. EKSPONIRANJE VERTEBRALNE
ARTERIJE U KO\u0160TENOM KANALU (V2).<\/h2>\n

<\/a><\/h1>\n<\/p>\n

\n

\"\"Proksimalni segment vertebralne arterije <\/em>nalazi se u spletu simpati\u010dkih nervnih <\/em>vlakana. Ona se ne smeju prese\u0107i du\u017e <\/em>prednje strane arterije jer \u0107e se razviti <\/em>Horner-ov sindrom.<\/em><\/p>\n

Prednji cervikalni pristup prvom segmentu vertebralne arterije se samo produ\u017eava distalno kad \u017eelimo da isprepari\u0161emo drugi segment. Incizija ide prednjom ivicom sternokleidomastoidnog mi\u0161i\u0107a. Ezofagus, karotidna arterija, vagus i jugularnu venu ekartiraju se medijalno.<\/p>\n

Tako dospevamo do prevertebralne fascije. Incidira se prevertebralna fascija. Eksponira se prednji spinalni ligament koji se tako\u0111e incidira. M. longus colli i m. longus capitis se odvajaju od svojih periostalnih pripoja i potiskuju lateralno, zajedno sa periostom. Tako mo\u017eemo da ogolimo prednje tuberkule transverzalnih produ\u017eetaka cervikalnih ki\u010dmenih pr\u0161ljenova.<\/p>\n

Obzirom da prednji kraci transverzalnih produ\u017eetaka cervikalnih pr\u0161ljenova \u010dine prednji zid ko\u0161tanog kanala vertebralne arterije moramo ih resecirati.<\/p>\n

Dletom i osteotomima odstranjujemo prednji zid vertebralnog ko\u0161tanog kanala. Potom se arterija osloba\u0111a prate\u0107ih vertebralnih vena koje znaju da prouzrokuju neugodna difuzna krvarenja. Ova krvarenja treba re\u0161avati bipolarnom elektrokoagulacijom, a \u010desto je potrebna i primena mikroskopa odnosno lupe za delikatnu hemostazu.<\/p>\n

Paravertebralni venski spletovi su bogatiji u intertransverzalnim prostorima, nego u samom ko\u0161tanom kanalu. Zato je u ko\u0161tanom segmentu arterije bolje ako joj se prilazi reseciranjem ko\u0161tanog krova kanala. Neposredno iza arterije nalaze se prednji korenovi cervikalnih nerava (ispod C2 nivoa).<\/p>\n

Otklanjanje prednjih lamina popre\u010dnih produ\u017eetaka cervikalnih pr\u0161ljenova je metod izbora za le\u010denje kompresije u nivou ko\u0161tanog kanala. Ovaj pristup ne treba koristiti za direktnu rekonstrukciju vertebralne arterije. Budu\u0107i da su u intertransverzalnim prostorma venski spletovi vrlo bogati, te\u0161ko se mo\u017ee ispreparisati arterijski segment dovoljan za formiranje anastomoze. Za anastomozu je bolje izabrati tre\u0107i segment vertebralne arterije (intertransverzalni prostor izme\u0111u C1 i C2.<\/p>\n<\/div>\n

\"\"<\/p>\n

\n

Disekcija vertebralne arterije od cervikalne simpati\u010dke anse. Simpati\u010dka vlakna koja spajaju srednji <\/em>i \u201czvezdasti\u201d vratni ganglion okru\u017euju proksimalni deo vertebralne arterije (A). Arterija se recesira <\/em>iznad orificijuma i provla\u010di bez lediranja simpatikusa.
Ovo je posebno delikatno ako je arterija <\/em>elongirana (kinking ili coiling).<\/em><\/p>\n<\/div>\n

\"\"<\/p>\n

\n

Supraklavikularni pristup po\u010detnom delu vertebralne arterije. Resekcija prednjeg skalenskog mi\u0161i\u0107a, <\/em>posle mobilisanja n. phrenicus-a.<\/em><\/p>\n<\/div>\n


\n<\/p>\n","protected":false},"excerpt":{"rendered":"

INDIKACIJE ZA REKONSTRUKCIJUVERTEBRALNE ARTERIJE 26.1. EKSPONIRANJE VERTEBRALNEARTERIJE U KO\u0160TENOM KANALU (V2). Proksimalni segment vertebralne arterije nalazi se u spletu simpati\u010dkih nervnih vlakana. Ona se ne smeju prese\u0107i du\u017e prednje strane arterije jer \u0107e se razviti Horner-ov sindrom. Prednji cervikalni pristup prvom segmentu vertebralne arterije se samo produ\u017eava distalno kad \u017eelimo da isprepari\u0161emo drugi segment. Incizija […]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":""},"class_list":["post-5509","page","type-page","status-publish","hentry"],"acf":[],"yoast_head":"\n26. 1. EKSPONIRANJE VERTEBRALNE ARTERIJE U KO\u0160TENOM KANALU (V2). - KAROTIDNA HIRURGIJA<\/title>\n<meta name=\"description\" content=\"Vertebralna arterija (A.vertebralis) zahteva vrlo delikatan hirur\u0161ki pristup. 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