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. 2019 Jun 28:10:127.
doi: 10.25259/SNI-16-2019. eCollection 2019.

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

Yuto Hatano  1 , Nakao Ota  1 , Kosumo Noda  1 , Yasuaki Okada  1 , Yosuke Suzuki  1 , Shusei Fukuyama  1 , Shuichi Tanada  1 , Atsumu Hashimoto  1 , Tomomasa Kondo  1 , Takanori Miyazaki  1 , Yu Kinoshita  1 , Hiroyasu Kamiyama  1 , Sadahisa Tokuda  1 , Rokuya Tanikawa  1
Affiliations

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

Yuto Hatano et al. Surg Neurol Int. .

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.

Keywords: Occipital artery; Occipital artery to posterior inferior cerebellar artery bypass; Suboccipital muscle dissection.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1:
Figure 1:
Enhanced computed tomography images of the suboccipital anatomy (left side). (a) Mastoid process (arrow); arrowhead: posterior belly of the digastric muscle. (b) The lateral running pattern showing an OA running lateral to the LNG. SPL: Splenius capitis muscle; LNG: Longissimus capitis muscle.
Figure 2:
Figure 2:
Incision for the lateral suboccipital approach (left side). Arrowhead: asterion, arrow: C2.
Figure 3:
Figure 3:
Medial pattern (left side). LNG: Longissimus capitis muscle, OA: Occipital artery.
Figure 4:
Figure 4:
Lateral pattern (left side). LNG: Longissimus capitis muscle, OA: Occipital artery.
Figure 5:
Figure 5:
The LNG has a superficial and deep insertion and the OA runs between the muscles. LNG: Longissimus capitis muscle, OA: Occipital artery.
See this image and copyright information in PMC

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