Clinical importance of the occipital artery in vascular lesions: A review of the literature

Abstract

The occipital artery (OA) is a critical artery in vascular lesions. However, a comprehensive review of the importance of the OA is currently lacking. In this study, we used the PubMed database to perform a review of the literature on the OA to increase our understanding of its role in vascular lesions. We also provided our typical cases to illustrate the importance of the OA. The OA has several variations. For example, it may arise from the internal carotid artery or anastomose with the vertebral artery. Therefore, the OA may provide a crucial collateral vascular supply source and should be preserved in these cases. The OA is a good donor artery. Consequently, it is used in extra- to intracranial bypasses for moyamoya disease (MMD) or aneurysms. The OA can be involved in dural arteriovenous fistula (DAVF) and is a feasible artery for the embolisation of DAVF. True aneurysms and pseudoaneurysms can occur in the OA; surgical resection and embolisation are the effective treatment approaches. Direct high-flow AVF can occur in the OA; embolisation treatment is a good option in such cases. The OA can also be involved in MMD and brain arteriovenous malformation (AVM) by forming transdural collaterals. For a patient in the prone position, if occipital and suboccipital craniotomies are performed, the OA can also be used for intraoperative angiography. In brief, the OA is a very important artery in vascular lesions.

Keywords: Occipital artery; clinical importance; review; vascular lesion.

Figure 1.

Anatomical CTA and DSA imaging of the normal OA. (a) CTA images showing the OA course (arrows). (b) DSA of the ECA showing the OA course (arrows). CTA: computed tomography angiography; DSA: digital subtraction angiography; ECA: external carotid artery; OA: occipital artery.

Figure 2.

Anastomosis between OA with VA in a normal case. (a) and (b) CTA showing the connection between the OA and the VA via radicular branches (arrows). (c) and (d) DSA of the VA and the ECA showing the connection between the OA and the VA via radicular branches (arrows). VA: vertebral artery.

Figure 3.

Anastomosis between OA with VA in an ICA occlusive case. (a) and (b) Anteroposterior and lateral DSA of the VA showing the connection between the OA and the VA via radicular branches (arrows). ICA: internal carotid artery.

Figure 4.

OA-PICA bypass in a case with a PICA aneurysm. (a) 3D DSA of VA showing an aneurysm on the origin of PICA (arrow). (b) DSA of the ECA showing the course of OA (arrow). (c) Postoperative CTA showing aneurysm clipping (black arrow) and OA-PICA bypass (white arrow). (d) Postoperative CTA showing the OA’s path into the posterior fossa (white arrow). PICA: posterior inferior cerebellar artery.

Figure 5.

Embolisation via the OA with Onyx in a DAVF case. (a) and (b) DSA of the ECA and the VA showing a DAVF supplied by the OA and the posterior meningeal artery (arrows). (c) DSA showing embolisation of the DAVF via the OA (arrow). (d) DSA of the VA showing that the DAVF was embolised completely. DAVF: dural arteriovenous fistula.

Figure 6.

Transdural collaterals between the OA and PCA in an MMD case. (a) and (b) Different arterial phases of DSA of OA showing the transdural anastomosis between the OA and PCA (arrow and ellipse). The PCA received its blood supply from the OA. (a) The early arterial phase. (b) The late arterial phase. DSA: digital subtraction angiography; MMD: moyamoya disease; PCA: posterior cerebral artery.

Figure 7.

Transdural collaterals between the OA and AVM in an AVM case. (a) and (b) Lateral DSA of the ICA and VA showing the AVM located at the parietal and occipital lobes. (c) DSA of the ECA showing the transdural collaterals between the OA and the AVM (ellipse). AVM: arteriovenous malformation.