Surgical microanatomy of the occipital artery for suboccipital muscle dissection and intracranial artery reconstruction

Abstract

Background: The occipital artery (OA) is an important donor artery for posterior fossa revascularization. Harvesting the OA is difficult in comparison to the superficial temporal artery because the OA runs between suboccipital muscles. Anatomical knowledge of the suboccipital muscles and OA is essential for harvesting the OA during elevation of the splenius capitis muscle (SPL) for reconstruction of the posterior inferior cerebellar artery. We analyzed the running pattern of the OA and its anatomic variations using preoperative and intraoperative findings. Methods: From April 2012 to March 2018, we surgically treated 162 patients with suboccipital muscle dissection by OA dissection using the lateral suboccipital approach. The running pattern and relationship between the suboccipital muscles and OA were retrospectively analyzed using the operation video and preoperative enhanced computed tomography (CT) images. The anatomic variation in the running pattern of the OA was classified into two types: lateral type, running lateral to the muscle and medial type, running medial to the longissimus capitis muscle (LNG). Results: The medial pattern was observed in 107 (66%) patients and the lateral pattern in 54 (33.3%); 1 (0.6%) patient had the OA running between the LNGs. Conclusion: Preoperative CT is effective in determining the running course of the OA, which is important for safely harvesting the OA during SPL elevation. There is a risk of causing OA injury in patients with the lateral pattern. This is the first report showing that the OA rarely runs in between the LNGs.

Far-lateral approach without C1 laminectomy for microsurgical treatment of vertebral artery and proximal posterior inferior cerebellar artery aneurysms: Experience from 48 patients

“…The V3 segment of the VA was exposed through the suboccipital triangle. 16 , 17 , 18 , 19 After retrosigmoid craniotomy was made, the posterolateral part of the foramen magnum was removed while preserving the posterior arch of C1. After the posterior condylar emissary vein was coagulated and cut, the condylar fossa was exposed, and the sigmoid magnum triangle, which is the posterior part of the jugular tubercle, was identified and drilled until the blue line of the hypoglossal canal was partially seen.…”

Pictorial Essay on Ultrasound and Magnetic Resonance Imaging of Paraspinal Muscles for Myofascial Pain Syndrome

“…The occipital artery can be observed coursing either medially (deep) or laterally (superficial) to the longissimus capitis (Figure 13A) [25]. Tracing caudally, an intramuscular tendon can be seen at the level between the C2 vertebra and the mastoid process (Figure 13B).…”

Microsurgical Treatment Strategy of Vertebral Artery Fusiform Aneurysm—From the Standpoint of Hemodynamic Integrity and Perforator Preservation

“…Prior to this procedure, we perform a layer-by-layer dissection of the suboccipital muscles, which allows us to systematically identify the occipital artery (OA), extracranial VA (V3 portion) in the suboccipital triangle, and the posterior condylar canal. These steps enable the OA-PICA bypass, proximal control by temporary clamping of the V3, and high-flow bypass using the V3 as a blood source (38)(39)(40). The actual procedural steps are shown in Supplementary Video 1.…”