Deep suboccipital exposure of the atlantic part of the left vertebral artery.  An extensive dissection of the left suboccipital region has exposed the atlantic part of the vertebral artery as it emerges from the transverse foramen of C2 (axis) vertebra enroute to the transverse foramen of the atlas and the superior border of its posterior arch. The laminae of these vertebrae are connected by a connective tissue bridge as the ligamentum flavum. Musculature associated with the spinous process of C2 has been largely removed with the exception of the right rectus capitis posterior major muscle. The smaller rectus capitis posterior minor muscles are in view with origins on the posterior tubercle of the atlas. Emerging from the intervertebral foramen between the atlas and axis is the C2 dorsal (spinal) root ganglion and the C2 spinal nerve. Dorsal rami are shown leaving the spinal nerve into the paraspinous musculature. (Image courtesy of PA Rubino)