Foramen arcuale: anatomical study and review of the literature

OBJECT: The neurosurgical literature is lacking information on the so-called foramen arcuale. When this foramen is present, the vertebral artery (VA) travels through it after exiting the transverse foramen of the atlas and prior to entering the cranium. METHODS: The authors performed a study in 60 cadavers to determine the incidence of the foramen arcuale and ascertain morphometric information on its anatomy. In specimens in which the foramen arcuale was observed, the authors studied the relationship between it and the VA. The authors identified a foramen arcuale in 5% of specimens. The mean length and thickness of the osseous struts that converted the groove for the VA into the foramen arcuale were 7.0 and 2.0 mm, respectively. The mean area of the identified foramina was 14.2 mm2. The mean area of the ipsilateral C-1 transverse foramina was 18 mm2 in specimens with a foramen arcuale. The mean measurements of the proximal, intraforaminal (foramen arcuale), and distal diameter of the V3 segment of the VA at the level of the foramen arcuale were 6, 4, and 5 mm, respectively. In all specimens the authors noted that the intraforaminal part of the V3 segment was grossly compressed. CONCLUSIONS: The authors found that the foramen arcuale may compress the V3 segment of the VA. Based on their postmortem study, however, they cannot conclude that compression at this location results in symptomatic VA insufficiency. Based on their review of the literature, it seems that symptomatic compression of the VA at this location may be alleviated in some patients with decompressive procedures.