The retroesophageal aberrant right subclavian artery (ARSA) is a variation of the aortic arch that occurs asymptomatically in most patients. However, when symptomatic, it is most commonly associated with dysphagia. ARSA has also been noted as a location of potentially severe aneurysms in some patients, as well as posing a risk during surgical interventions in the esophageal region. This case study analyzes two individuals with ARSA morphology in comparison to a normal sample in order to gain a better anatomical understanding of this anomaly, potentially leading to better risk assessment of ARSA patients going forward. The diameter of the ARSA vessel was found to be substantially larger than both the right subclavian artery and brachiocephalic trunk of the subjects with classic aortic arch anatomy. As many ARSA individuals are asymptomatic, we hypothesize that the relative size of the ARSA may dictate its contribution to the presence and/or severity of associated symptomatology.

Occipital neuralgia (ON) is a condition defined as a headache characterized by paroxysmal burning and stabbing pain located in the distribution of the greater occipital nerve (GON), lesser occipital nerve (LON), or third occipital nerves (TON). This condition can be severely impairing in symptomatic patients and is known to have numerous etiologies deriving from various origins such as trauma, anatomical abnormalities, tumors, infections, and degenerative changes. This study reports four cases of a previously undescribed anatomical variant in which the (spinal) accessory nerve (SAN) fuses with the LON before piercing the sternocleidomastoid (SCM). The fusion of these two nerves and their route through the SCM points to a potential location for nerve compression within the SCM and, in turn, another potential source of ON. This anatomical presentation has clinical significance as it provides clinicians with another possible cause of ON to consider when diagnosing patients who present with complaints of a headache. Additionally, this study explores the prevalence of piercing anatomy of the LON and GAN and discusses their clinical implications.

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