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Kandathil SA, Dengler LS, Hirtler L. First standardized assessment of perforators and perforasomes of the occipital artery - an anatomical study. Ann Anat 2024:152241. [PMID: 38460857 DOI: 10.1016/j.aanat.2024.152241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 02/11/2024] [Accepted: 03/05/2024] [Indexed: 03/11/2024]
Abstract
BACKGROUND Flaps have become an integral part of plastic and reconstructive surgery. The robust blood supply of such flaps is a prerequisite to reduce flap failure. Despite the reported versatility of the occipital flap, comprehensive anatomical studies on its perforators and perforasomes are lacking. Hence, we examined the perforators originating from the occipital artery and their associated perforasomes, aiming to fill this knowledge gap for reconstructive surgery techniques. METHODS 39 of 40 occipital arteries of 20 fresh anatomical head specimens were dissected. Perforators with a least an outer diameter of 0.50mm were identified and injected with dye to color their respective perforasomes. Location and size of the colored skin areas were determined as well as the location of their perforators were documented and analyzed. RESULTS In total, 183 perforators were found and described. The mean diameter of these vessels was 0.88±0.27mm (0.5-2.1mm). The mean area of the perforasomes was 1288.26±662.51mm2 (144.60-3890.60mm2). They were localized over the whole nuchal and occipital area. Lastly, perforator diameters were significantly associated with the size of their resulting perforasomes. CONCLUSION This study is the first comprehensive overview of perforators and associated perforasomes of the occipital artery on a respectable amount of specimen. The arterial supply of big portions of the occipital and nuchal area is provided solely by the perforators of the occipital artery. For flap surgery, perforator diameter is a crucial detail to be considered in the decision-making process.
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Affiliation(s)
- Sam Augustine Kandathil
- Division of Anatomy, Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria; Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Lukas Sebastian Dengler
- Division of Anatomy, Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria
| | - Lena Hirtler
- Division of Anatomy, Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria.
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Saglam L, Gayretli O, Coskun O, Kale A. Morphological features of the greater occipital nerve and its possible importance for interventional procedures. J Anat 2024; 244:312-324. [PMID: 37777340 PMCID: PMC10780152 DOI: 10.1111/joa.13959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 09/18/2023] [Accepted: 09/18/2023] [Indexed: 10/02/2023] Open
Abstract
Being one of the most prevalent neurological symptoms, headaches are burdensome and costly. Blocks and decompression surgeries of the greater occipital nerve (GON) have been frequently used for migraine, cervicogenic headache, and occipital neuralgia which are classified under headache by International Headache Society. Knowledge of complex anatomy of GON is crucial for its decompression surgery and block. This study was performed to elucidate anatomical features of this nerve in detail. Forty-one cadavers were dissected bilaterally. According to its morphological features, GON was classified into four main types that included 18 subtypes. Moreover, potential compression points of the nerve were defined. The number of branches of the GON up to semispinalis capitis muscle and the number of its branches that were sent to this muscle were recorded. The most common variant was that the GON pierced the aponeurosis of the trapezius muscle, curved around the lower edge of the obliquus capitis inferior muscle, and was loosely attached to the obliquus capitis inferior muscle (Type 2; 61 sides, 74.4%). In the subtypes, the most common form was Type 2-A (44 sides, 53.6%), in which the GON pierced the aponeurosis of each of the trapezius muscle and fibers of semispinalis muscle at one point and there was a single crossing of the GON and occipital artery. Six potential compression points of the GON were detected. The first point was where the nerve crossed the lower border of the obliquus capitis inferior muscle. The second and third points were at its piercing of the semispinalis capitis muscle and the muscle fibers/aponeurosis of the trapezius, respectively. Fourth, fifth, and sixth compression points of GON were located where the GON and occipital artery crossed each other for the first, second, and third times, respectively. On 69 sides, 1-4 branches of the GON up to the semispinalis capitis muscle were observed (median = 1), while 1-4 branches of GON were sent to the semispinalis capitis muscle on 67 sides (median = 1). The novel anatomical findings described in this study may play a significant role in increasing the success rate of invasive interventions related with the GON.
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Affiliation(s)
- Latif Saglam
- Department of Anatomy, Istanbul Faculty of MedicineIstanbul UniversityIstanbulTurkey
| | - Ozcan Gayretli
- Department of Anatomy, Istanbul Faculty of MedicineIstanbul UniversityIstanbulTurkey
| | - Osman Coskun
- Department of Anatomy, Istanbul Faculty of MedicineIstanbul UniversityIstanbulTurkey
| | - Aysin Kale
- Department of Anatomy, Istanbul Faculty of MedicineIstanbul UniversityIstanbulTurkey
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Tatsumi H, Nunokawa T, Chinen N. Occipital Artery Involvement in Giant Cell Arteritis. Intern Med 2023:2745-23. [PMID: 37926532 DOI: 10.2169/internalmedicine.2745-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2023] Open
Affiliation(s)
- Hirokazu Tatsumi
- Department of Internal Medicine, Tama Nambu Chiiki Hospital, Japan
- Department of Rheumatic Diseases, Tokyo Metropolitan Tama Medical Center, Japan
| | | | - Naofumi Chinen
- Department of Internal Medicine, Tama Nambu Chiiki Hospital, Japan
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Yamano A, Hayakawa M, Ito Y, Hidano A, Hosoo H, Marushima A, Ishikawa E, Matsumaru Y. Anomalous Cervical External Carotid Artery-Internal Carotid Artery Anastomosis Diagnosed Using Digital Subtraction Angiography: A Case Report. Cureus 2023; 15:e47878. [PMID: 38021755 PMCID: PMC10681371 DOI: 10.7759/cureus.47878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2023] [Indexed: 12/01/2023] Open
Abstract
Anomalous external carotid artery (ECA)-internal carotid artery (ICA) anastomosis is a rare variant of cervical carotid artery formation that forms an arterial ring in the cervical segment, and its embryological mechanism is still unknown. We report a case of a 41-year-old woman who was incidentally diagnosed with this arterial variation using digital subtraction angiography. The angiography revealed the occipital artery arising from the anastomotic vessel and the ascending pharyngeal artery arising from the ICA near the anastomosis. The proximal ICA was smaller in diameter than the proximal ECA, but it was not stenotic and had sufficient caliber for the distal blood flow. It is commonly believed that the persistence of primitive vessels is the result of agenesis or hypoplasia of the proximal artery. In our case, the anomalous vessel was considered to be the remnant of a primitive anastomosis between the ECA and the ICA via the pharyngo-occipital system, and the narrowing of the proximal ICA may be the result of the remaining ECA-ICA anastomosis.
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Affiliation(s)
- Akinari Yamano
- Department of Stroke and Cerebrovascular Diseases, University of Tsukuba Hospital, Tsukuba, Ibaraki, JPN
- Department of Neurosurgery, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, JPN
| | - Mikito Hayakawa
- Department of Stroke and Cerebrovascular Diseases, University of Tsukuba Hospital, Tsukuba, Ibaraki, JPN
- Department of Neurology, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, JPN
| | - Yoshiro Ito
- Department of Stroke and Cerebrovascular Diseases, University of Tsukuba Hospital, Tsukuba, Ibaraki, JPN
- Department of Neurosurgery, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, JPN
| | - Atsushi Hidano
- Department of Stroke and Cerebrovascular Diseases, University of Tsukuba Hospital, Tsukuba, Ibaraki, JPN
- Department of Neurosurgery, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, JPN
| | - Hisayuki Hosoo
- Department of Stroke and Cerebrovascular Diseases, University of Tsukuba Hospital, Tsukuba, Ibaraki, JPN
- Department of Neurosurgery, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, JPN
| | - Aiki Marushima
- Department of Stroke and Cerebrovascular Diseases, University of Tsukuba Hospital, Tsukuba, Ibaraki, JPN
- Department of Neurosurgery, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, JPN
| | - Eiichi Ishikawa
- Department of Neurosurgery, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, JPN
| | - Yuji Matsumaru
- Department of Stroke and Cerebrovascular Diseases, University of Tsukuba Hospital, Tsukuba, Ibaraki, JPN
- Department of Neurosurgery, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, JPN
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Ostrowski P, Bonczar M, Yika ADC, Czekańska H, Batko J, Wojciechowski W, Ghosh SK, Jaworek-Troć J, Piątek-Koziej K, Juszczak A, Gładysz T, Lusina D, Walocha J, Koziej M. The occipital-vertebral anastomosis revisited. Folia Morphol (Warsz) 2022; 82:615-623. [PMID: 36472395 DOI: 10.5603/fm.a2022.0101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 11/14/2022] [Accepted: 11/14/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND The goal of the study was to provide relevant data about the location and prevalence of the occipital artery-vertebral artery (OA-VA) anastomosis in patients without visible occlusive disease, as well as to thoroughly discuss the clinical significance of these anastomotic channels. Furthermore, the morphometric properties of the OA and its branches were also analysed. MATERIALS AND METHODS A retrospective study was carried out to indicate anatomical variations, their prevalence, and morphometrical data on the OA and its branches. The study was performed on 55 randomly selected computed tomography angiographies (CTA) of the head and neck region. Each CTA result was analysed bilaterally. Thus, 110 results were originally assessed. RESULTS The OA median maximal diameter was demonstrated at 4.85 mm (lower quartile [LQ]: 4.11; upper quartile [UQ]: 5.53) and the median maximal diameter of VA at 3.60 mm (LQ: 2.79; UQ: 4.38). The distances between OA and its branches were also measured giving a median result of 21.73, 30.29, 60.84, 34.88, 18.02, 55.16 mm for the lower and upper sternocleidomastoid branch, meningeal branch, mastoid branch, and descending branch, respectively. The median distance between OA and its first anastomosis was set to be 51.15 mm (LQ: 37.20; UQ: 60.10). Moreover, a set of additional measurements was carried out in order to create a three-dimensional anatomical heat-map of the occurrence of the OA-VA anastomosis. CONCLUSIONS Knowledge about the anatomy of the OA-VA anastomosis might be of immense importance to avoid potentially fatal complications during embolisation of the OA and its branches.
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Affiliation(s)
- P Ostrowski
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - M Bonczar
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | | | - H Czekańska
- Department of Anatomy, Medical University of Warsaw, Poland
| | - J Batko
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - W Wojciechowski
- Department of Radiology, Jagiellonian University Medical College, Krakow, Poland
| | - S K Ghosh
- Department of Anatomy, All India Institute of Medical Sciences, Patna, India
| | - J Jaworek-Troć
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - K Piątek-Koziej
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - A Juszczak
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - T Gładysz
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - D Lusina
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - J Walocha
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - M Koziej
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland.
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McAvoy M, McGrath M, Miller CA, Shenoy VS, Sekhar LN. Traumatic pseudoaneurysm of the occipital artery treated with open surgical ligation: 2-Dimensional Operative Video. World Neurosurg 2022:S1878-8750(22)01384-5. [PMID: 36184043 DOI: 10.1016/j.wneu.2022.09.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 09/22/2022] [Indexed: 10/14/2022]
Abstract
Scalp pseudoaneurysms most commonly occur due to trauma and are often in the superficial temporal artery due to the lack of soft tissue coverage between skin and bone, making it more vulnerable anatomically.1,2 Pseudoaneurysms of the occipital artery (OA) also can occur but are extremely rare.2-4 An 80-year-old man presented with scalp bleeding and a small left-sided posterior scalp laceration after a fall and a head strike 10-days prior. He was admitted and during his 2-week hospital stay, the occipital laceration continued to re-bleed. He developed a 2cm pulsatile ulcerative mass with central necrosis on the left nuchal ridge. Computed tomography (CT) angiography revealed an ovoid left occipital lesion measuring 1.3x2.5x2.3cm with delayed contrast filling and partial thrombosis. The base of the lesion had dense contrast filling continuous with the OA diagnostic of OA pseudoaneurysm. OA pseudoaneurysm may be treated endovascularly or surgically. While surgical resection is the most common treatment, minimally invasive techniques have been successfully done through direct injection of N-butyl cyanoacrylate or endovascular embolization. The clinical presentation of this case was unique because this patient had an ulcerated lesion with central necrosis overlying the pseudoaneurysm. Endovascular management alone would not address the open lesion which is at high risk for infection. The risk of infection would increase after embolization of the occipital artery, causing further necrosis of the tissue.
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Sun L, Qi M, Shao X, Chen S, Fang X, Zhou W, Zhou W, Chen H, He G, Fan X, Sun Y, Di G, Jiang X. Modified Skin Incision and Location of Burr-Hole Surgery via a Retrosigmoid Approach: An Anatomical Study. Skull Base Surg 2022; 84:98-104. [PMID: 36743712 PMCID: PMC9897899 DOI: 10.1055/s-0041-1740971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 11/12/2021] [Indexed: 02/07/2023]
Abstract
Objective This study aims to reduce the tissue damage during craniotomy with retrosigmoid approach. A modified sickle-shaped skin incision was developed, and a new burr-hole positioning method was proposed. Methods Five adult cadaveric heads (10 sides) were used in this study. The sickle-shaped skin incision was performed during craniotomy. The nerves, blood vessels, and muscles were observed and measured under a microscope. Additionally, 62 dry adult skull specimens (left sided, n = 35; right sided, n = 27) were used to measure the distance between the most commonly used locating point (asterion [Ast] point) and the posteroinferior point of the transverse sigmoid sinus junction (PSTS) (Ast-PSTS), as well as the distance between the new locating O point and the PSTS (O-PSTS). Then, the reliability of the new locating O point was validated on the same five adult cadaveric heads (10 sides) used for the sickle-shaped skin incision. Results The sickle-shaped skin incision reduced the damage to the occipital nerves, blood vessels, and muscles during the surgery via a retrosigmoid approach. The dispersion and variability of O-PSTS were smaller than those of Ast-PSTS. Conclusion The sickle-shaped skin incision of the retrosigmoid approach can reduce the tissue damage and can completely expose the structures in the cerebellopontine angle. The modified O point is a more reliable locating point for a burr-hole surgery than the Ast point.
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Affiliation(s)
- Lean Sun
- Department of Neurosurgery, Yijishan Hospital, Wannan Medical College, Wuhu, China
| | - Min Qi
- Department of Neurosurgery, Yijishan Hospital, Wannan Medical College, Wuhu, China
| | - Xuefei Shao
- Department of Neurosurgery, Yijishan Hospital, Wannan Medical College, Wuhu, China
| | - Sansong Chen
- Department of Neurosurgery, Yijishan Hospital, Wannan Medical College, Wuhu, China
| | - Xinyun Fang
- Department of Neurosurgery, Yijishan Hospital, Wannan Medical College, Wuhu, China
| | - Wei Zhou
- Department of Neurosurgery, Yijishan Hospital, Wannan Medical College, Wuhu, China
| | - Wei Zhou
- Department of Neurosurgery, Yijishan Hospital, Wannan Medical College, Wuhu, China
| | - Hao Chen
- Department of Neurosurgery, Yijishan Hospital, Wannan Medical College, Wuhu, China
| | - Guoyuan He
- Department of Neurosurgery, Yijishan Hospital, Wannan Medical College, Wuhu, China
| | - Xiran Fan
- Department of Neurosurgery, Yijishan Hospital, Wannan Medical College, Wuhu, China
| | - Yongkang Sun
- Department of Neurosurgery, Yijishan Hospital, Wannan Medical College, Wuhu, China
| | - Guangfu Di
- Department of Neurosurgery, Yijishan Hospital, Wannan Medical College, Wuhu, China
| | - Xiaochun Jiang
- Department of Neurosurgery, Yijishan Hospital, Wannan Medical College, Wuhu, China,Address for correspondence Xiaochun Jiang Department of Neurosurgery, Yijishan Hospital, Wannan Medical College2 Wast Zheshan Road, Wuhu, Anhui 241001China
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Furtado SV, Quryshi SA, Jagannatha AT, Hegde AS. Segmental Agenesis of External Carotid Artery from Common Carotid Artery with Anomalous Reformation through Occipital Artery Anastomoses. Neurol India 2022; 69:1824-1827. [PMID: 34979699 DOI: 10.4103/0028-3886.333480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Anomalous origin of extracranial and intracranial carotid system is subject to permutations of embryonal regression of the developing primitive embryonal vasculature. We present a case of segmental agenesis of left external carotid artery from the cervical carotid circulation. The entire left external carotid artery was supplied by the vertebral artery through muscular branches via the occipital artery. This anomaly of proximal external carotid agenesis with the entire vascular tree dependent on the posterior circulation via occipital artery muscular collaterals is unique and has not been described before. We discuss this anomaly with its embryology, clinical implications, and its relationship to a Proatlantal artery.
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Affiliation(s)
- Sunil V Furtado
- Department of Neurosurgery, Ramaiah Medical College and Hospital, Bangalore, Karnataka, India
| | - Syed A Quryshi
- Department of Neurosurgery, Ramaiah Medical College and Hospital, Bangalore, Karnataka, India
| | - Aniruddha T Jagannatha
- Department of Neurosurgery, Ramaiah Medical College and Hospital, Bangalore, Karnataka, India
| | - Alangar S Hegde
- Department of Neurosurgery, Ramaiah Medical College and Hospital, Bangalore, Karnataka, India
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Rudnay M, Rjašková G, Lehotská V. Internal carotid artery anatomy - not always straightforward. Vascular 2022; 31:551-553. [PMID: 34983265 DOI: 10.1177/17085381211069716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To present a rare variant of internal carotid artery anatomy. METHODS Case report presenting CT angiography finding of internal carotid anatomy variant. RESULTS We present the case of an unusual origin of the occipital artery from cervical portion of the internal carotid artery as an incidental finding during CT angiography of the carotid arteries. In discussion, we discuss the possible embryological basis, incidence and prevalence of such finding and its possible clinical implications. CONCLUSION One of the specific aspects of carotid arteries is their straightforward anatomy - the cervical portion of internal carotid artery, unlike the external carotid, does not give origin to any branches - this aspect is even used as a highlight for orientation, e.g. during ultrasound examination. However, although rare, variants exist, and sometimes can have clinical importance - in the endovascular access or surgical treatment.
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Affiliation(s)
- Maroš Rudnay
- Department of Radiology and Medical Imaging, 83513L. Pasteur University Hospital, Košice, Slovakia.,II Department of Radiology, 59063Faculty of Medicine of Comenius University in Bratislava and St. Elizabeth's Cancer Institute, Bratislava, Slovakia
| | - Gabriela Rjašková
- Department of Radiology and Medical Imaging, 83513L. Pasteur University Hospital, Košice, Slovakia
| | - Viera Lehotská
- II Department of Radiology, 59063Faculty of Medicine of Comenius University in Bratislava and St. Elizabeth's Cancer Institute, Bratislava, Slovakia
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Luan T, Yu J. Anatomical features of the occipital artery on CTA and differences between patients with/without stenosis and occlusion of the internal carotid artery. Med Int (Lond) 2021; 2:3. [PMID: 36700153 PMCID: PMC9829191 DOI: 10.3892/mi.2021.28] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 12/28/2021] [Indexed: 01/28/2023]
Abstract
The understanding of the basic anatomy of the occipital artery (OA) is crucial, and computed tomography angiography is an effective tool for this purpose. In the present study, a comparison between healthy subjects and patients with internal carotid artery (ICA) stenosis and occlusion was made. The following parameters were measured: Age, sex, diameters and lengths of the OA in different locations, distance from the edge of the foramen magnum to the OA and the distance from the midline to the OA at the level of the superior nuchal line. A total of 205 participants who met the inclusion criteria were selected for further investigation. In addition, 50 healthy subjects (100 sides, left and/or right) were selected as the control group. A total of 155 patients (180 sides, left and/or right) were selected as the stenosis and occlusion groups, including the mild and moderate ICA stenosis group (50 sides, left and/or right), severe ICA stenosis group (80 sides, left and/or right) and the ICA occlusion group (50 sides, left and right). General information, measured parameters and statistical analysis results are provided for these groups. No significant differences were observed in the anatomical parameters of the OA among these groups. Thus, in addition to providing anatomical data, the present study demonstrates that stenosis and the occlusion of the ICA do not significantly alter the anatomy of the OA.
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Affiliation(s)
- Tengfei Luan
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Jinlu Yu
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China,Correspondence to: Dr Jinlu Yu, Department of Neurosurgery, The First Hospital of Jilin University, 1 Xinmin Avenue, Changchun, Jilin 130021, P.R. China ;
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11
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Foo SY, Swaminathan SK, Krings T. Dilated MMA sign in cDAVF and other arterial feeders on 3D TOF MRA. Neuroradiol J 2021; 35:290-299. [PMID: 34449286 PMCID: PMC9244742 DOI: 10.1177/19714009211041530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Among the varied causes of pulsatile tinnitus, the condition that can cause
severe mortality and morbidity is a cranial dural arteriovenous fistula
(cDAVF). This study aimed to assess the diagnostic accuracy of the dilated
middle meningeal artery on three-dimensional time-of-flight magnetic
resonance angiography in cranial dural arteriovenous fistula and to identify
other feeders that can aid in the detection of these lesions. Method Magnetic resonance angiography and digital subtraction angiography data of
all patients with cranial dural arteriovenous fistula treated in a single
tertiary referral center between 2007–2020 were included. The middle
meningeal artery and other feeders recorded from digital subtraction
angiography were assessed on magnetic resonance angiography. Results The overall agreement between readers in identifying the dilated middle
meningeal artery was substantial (κ = 0.878, 95% confidence interval:
0.775–0.982). The dilated middle meningeal artery indicated the presence of
a cranial dural arteriovenous fistula with a sensitivity of 79.49% (95%
confidence interval: 66.81–92.16), specificity of 100% (95% confidence
interval: 100.00–100.00), and negative predictive value of 94.56% (95%
confidence interval: 90.89–98.02). An area under the curve of 0.8341 was
observed for the ipsilateral middle meningeal artery, with a sensitivity of
92.2% and a specificity of 75.0% at a cut-off of 0.30 mm for identifying a
cranial dural arteriovenous fistula. Of 73 other feeders, the occipital,
meningohypophyseal trunk, ascending pharyngeal, and posterior meningeal
arteries contributed to a large proportion visualized on magnetic resonance
angiography (83.6% (41/49)). Conclusion The dilated middle meningeal artery sign is useful for identifying a cranial
dural arteriovenous fistula. Dilatation of the occipital and ascending
pharyngeal arteries and meningohypophyseal trunk should be assessed to
facilitate the detection of a cranial dural arteriovenous fistula,
particularly in the transverse-sigmoid and petrous regions.
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Affiliation(s)
- Sin Y Foo
- Diagnostic Neuroradiology Fellowship Program, Temerty Faculty of Medicine, Canada
| | | | - Timo Krings
- Division of Neuroradiology, Toronto Western Hospital (University Health Network), Canada
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12
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Nakamura A, Kawashima A, Andrade-Barazarte H, Funatsu T, Hernesniemi J, Kawamata T. Occipital artery to middle cerebral artery bypass in pediatric moyamoya disease: rescue therapy after failed revascularization. J Neurosurg Pediatr 2021; 27:429-436. [PMID: 33450732 DOI: 10.3171/2020.8.peds20424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 08/10/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Patients with pediatric moyamoya disease (PMMD) showing recurrent symptoms or decreased cerebral blood flow after initial revascularization therapy may require additional revascularization to improve their clinical condition. The authors evaluated the clinical and hemodynamic benefits of an occipital artery (OA)-middle cerebral artery (MCA) bypass for patients with PMMD who have undergone an initial revascularization procedure. METHODS The authors retrospectively identified 9 patients with PMMD who had undergone OA-MCA bypass between March 2013 and December 2017, and who had received a previous superficial temporal artery-MCA bypass. The following clinical data were collected: initial revascularization procedure, symptoms (presence or recurrence), pre- and postoperative cerebral blood flow and cerebrovascular reactivity (CVR) changes, posterior cerebral artery (PCA) stenosis, PCA-related and nonrelated symptoms, and latest follow-up. RESULTS Preoperatively, all patients (n = 9) suffered non-PCA-related recurrent symptoms, and 4 had PCA-related symptoms. At 1-year follow-up, all patients with PCA-related symptoms showed complete recovery. Additionally, 8 (89%) patients with non-PCA symptoms experienced improvement. Only 1 (11%) patient showed no improvement after the surgical procedure. The mean pre- and postoperative CVR values of the MCA territory were 14.8% and 31.3%, respectively, whereas the respective mean CVR values of the PCA territory were 22.8% and 40.0%. CONCLUSIONS The OA-MCA bypass is an effective rescue therapy to improve the clinical condition and hemodynamic changes caused by PMMD in patients who experience recurrent symptoms after initial revascularization.
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Affiliation(s)
- Akikazu Nakamura
- 1Department of Neurosurgery, Tokyo Women's Medical University, Yachiyo Medical Center, Chiba, Japan
| | - Akitsugu Kawashima
- 1Department of Neurosurgery, Tokyo Women's Medical University, Yachiyo Medical Center, Chiba, Japan
| | - Hugo Andrade-Barazarte
- 2Department of Neurosurgery, Juha Hernesniemi International Center for Neurosurgery, Henan People's Provincial Hospital, University of Zhengzhou, China; and
| | - Takayuki Funatsu
- 3Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Juha Hernesniemi
- 2Department of Neurosurgery, Juha Hernesniemi International Center for Neurosurgery, Henan People's Provincial Hospital, University of Zhengzhou, China; and
| | - Takakazu Kawamata
- 3Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan
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Prigge L, van Schoor AN, Bosenberg AT. Anatomy of the greater occipital nerve block in infants. Paediatr Anaesth 2019; 29:945-949. [PMID: 31270900 DOI: 10.1111/pan.13693] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 06/14/2019] [Accepted: 06/24/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Pain relief for posterior fossa craniotomies as well as occipital neuralgia, are indications for the use of the greater occipital nerve block in children. The greater occipital nerve originates from the C2 spinal nerve and is accompanied by the occipital artery as it supplies the posterior scalp. AIMS The aim of this study was to develop a unique, yet simple technique for blocking the greater occipital nerve in children through the evaluation of the anatomy of this nerve and the accompanying occipital artery in the occipital region. METHODS The greater occipital nerve and occipital artery were dissected and exposed in six formalin-fixed cadavers (five infants [average age of 51.4 days] and one 2-year-old) from the Department of Anatomy, University of Pretoria. Measurements between the nerve and selected bony landmarks were obtained. The relationship between the greater occipital nerve and the occipital artery at the trapezius muscle hiatus was also evaluated. RESULTS The greater occipital nerve is on average 22.6 ± 5.6 mm from the external occipital protuberance in infants. The average width of the medial three fingers measured at the proximal interphalangeal joint, for each respective cadaver is 20.4 ± 4.0 mm, with a strong correlation coefficient of 0.97 between the aforementioned distances. In 83.3% of the specimens, the occipital artery lies lateral to the greater occipital nerve at the trapezius muscle hiatus. CONCLUSION In infants, the greater occipital nerve can be blocked approximately 23 mm from the external occipital protuberance, medial to the occipital artery. This distance is equal to the width of the medial three fingers at the proximal interphalangeal joint of the patient.
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Affiliation(s)
- Lané Prigge
- Department of Anatomy, School of Medicine, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa.,Department of Anatomy, School of Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Albert N van Schoor
- Department of Anatomy, School of Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Adrian T Bosenberg
- Department of Anesthesiology and Pain Management, University Washington and Seattle Children's Hospital, Seattle, WA, USA
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Tayebi Meybodi A, Lawton MT, Moreira LB, Zhao X, Lang MJ, Nakaji P, Preul MC. Retromastoid-transmuscular identification and harvest of the occipital artery during retrosigmoid craniotomy. J Neurosurg 2019; 133:1-8. [PMID: 31299653 DOI: 10.3171/2019.4.jns19323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 04/17/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Harvesting the occipital artery (OA) is challenging. The subcutaneous OA is usually found near the superior nuchal line and followed proximally, requiring a large incision and risking damage to the superficially located OA. The authors assessed the anatomical feasibility and safety of exposing the OA through a retromastoid-transmuscular approach. METHODS Using 10 cadaveric heads, 20 OAs were harvested though a 5-cm retroauricular incision placed 5 cm posterior to the external auditory meatus. The underlying muscle layers were sequentially cut and recorded before exposing the OA. Changes in the orientation of muscle fibers were used as a roadmap to expose the OA without damaging it. RESULTS The suboccipital segment of the OA was exposed without damage after incising two consecutive layers of muscles and their investing fasciae. These muscles displayed different fiber directions: the superficially located sternocleidomastoid muscle with vertically oriented fibers, and the underlying splenius capitis with anteroposteriorly (and mediolaterally) oriented fibers. The OA could be harvested along the entire length of the skin incision in all specimens. If needed, the incision can be extended proximally and/or distally to follow the OA and harvest greater lengths. CONCLUSIONS This transmuscular technique for identification of the OA is a reliable method and may facilitate exposure and protection of the OA during a retrosigmoid approach. This technique may obviate the need for larger incisions when planning a bypass to nearby arteries in the posterior circulation via a retrosigmoid craniotomy. Additionally, the small skin incision can be enlarged when a different craniotomy and/or bypass is planned or when a greater length of the OA is needed to be harvested.
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15
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Niwa R, Kimura T, Ichi S. Occipital artery-anterior cerebral artery bypass with posterior auricular artery-middle cerebral artery bypass for stenosis of the internal carotid artery bifurcation. Br J Neurosurg 2019; 35:792-795. [PMID: 31144536 DOI: 10.1080/02688697.2019.1620919] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Superficial temporal artery (STA)-middle cerebral artery (MCA) bypass, and STA-anterior cerebral artery (ACA) bypass, are options for direct revascularisation of anterior circulation. However, some patients don't have a suitable STA to use as a donor, so an alternative procedure must be performed. A 59-year-old, right-handed man presented with dysphasia and right-sided hemiparesis due to a transient ischaemic attack. Imaging studies revealed severe stenosis of the left internal carotid artery bifurcation. Iodoamphetamine single photon emission computed tomography demonstrated reduced cerebrovascular reserve capacity in the left hemisphere. The patient was started on antiplatelet therapy, but the ischaemic attacks persisted after one month. Thus, revascularisation of the ACA and MCA territories was considered. Digital subtraction angiography revealed prominence in the left occipital artery (OA) and posterior auricular artery (PAA), while the left STA was hypoplastic, terminating at the squamous suture level. Therefore, anastomoses were performed between both the OA and ACA and the PAA and MCA. Revascularisation was successful, and the ischaemic attacks disappeared. OA-ACA bypass, together with PAA-MCA bypass, may be effective for wide cerebral revascularisation when the STA is not available.
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Affiliation(s)
- Ryoko Niwa
- a Department of Neurosurgery , Japanese Red Cross Medical Center , Tokyo , Japan
| | - Toshikazu Kimura
- a Department of Neurosurgery , Japanese Red Cross Medical Center , Tokyo , Japan
| | - Shunsuke Ichi
- a Department of Neurosurgery , Japanese Red Cross Medical Center , Tokyo , Japan
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16
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Shin KJ, Kim HS, O J, Kwon HJ, Yang HM. Anatomical consideration of the occipital cutaneous nerves and artery for the safe treatment of occipital neuralgia. Clin Anat 2018; 31:1058-1064. [PMID: 29752841 DOI: 10.1002/ca.23210] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Accepted: 05/08/2018] [Indexed: 12/17/2022]
Abstract
There is no standardized approach to the greater occipital nerve (GON) block technique for treating occipital neuralgia. The aim of the present study was to validate the previously-suggested guidelines for conventional injection techniques and to provide navigational guidelines for safe GON block. The GON, lesser occipital nerve (LON) and occipital artery (OA) were carefully dissected in the occipital region of embalmed cadavers. Using a 3 D digitizer, the GON, LON, and OA were observed on the two reference lines. The distances between the landmarks were recorded and statistically analyzed. On the superior nuchal line, the mean distances between the external occipital protuberance (EOP) and the most medial branch of the GON was 33.5 mm. The mean distance between the EOP and the most medial branch of the OA was 37.4 mm. On the EOP-mastoid process (MP) line, the GON was on the medial third and the LON the lateral third of the EOP-MP line. The safe injection points on the EOP-MP line are about 3 cm from the EOP, 1 cm inferior parallel to the EOP-MP line, and about 3 cm away from the MP. Clin. Anat. 31:1058-1064, 2018. © 2018 Wiley Periodicals, Inc.
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Affiliation(s)
- Kang-Jae Shin
- Department of Anatomy and Cell Biology, Dong-A University, College of Medicine, Busan, Republic of Korea
| | - Hong-San Kim
- Department of Anatomy, School of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Jehoon O
- Department of Anatomy, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyun-Jin Kwon
- Department of Anatomy, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hun-Mu Yang
- Department of Anatomy, Yonsei University College of Medicine, Seoul, Republic of Korea
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17
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Benet A, Tabani H, Ding X, Burkhardt JK, Rodriguez Rubio R, Tayebi Meybodi A, Nisson P, Kola O, Gandhi S, Yousef S, Lawton MT. The transperiosteal "inside-out" occipital artery harvesting technique. J Neurosurg 2018; 130:207-212. [PMID: 29372878 DOI: 10.3171/2017.6.jns17518] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Accepted: 06/13/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The occipital artery (OA) is a frequently used donor vessel for posterior circulation bypass procedures due to its proximity to the recipient vessels and its optimal caliber, length, and flow rate. However, its tortuous course through multiple layers of suboccipital muscles necessitates layer-by-layer dissection. The authors of this cadaveric study aimed to describe a landmark-based novel anterograde approach to harvest OA in a proximal-to-distal "inside-out" fashion, which avoids multilayer dissection. METHODS Sixteen cadaveric specimens were prepared for surgical simulation, and the OA was harvested using the classic (n = 2) and novel (n = 14) techniques. The specimens were positioned three-quarters prone, with 45° contralateral head rotation. An inverted hockey-stick incision was made from the spinous process of C-2 to the mastoid tip, and the distal part of the OA was divided to lift up a myocutaneous flap, including the nuchal muscles. The OA was identified using the occipital groove (OG), the digastric muscle (DM) and its groove (DG), and the superior oblique muscle (SOM) as key landmarks. The OA was harvested anterogradely from the OG and within the flap until the skin incision was reached (proximal-to-distal technique). In addition, 35 dry skulls were assessed bilaterally (n = 70) to study additional craniometric landmarks to infer the course of the OA in the OG. RESULTS The OA was consistently found running in the OG, which was found between the posterior belly of the DM and the SOM. The mean total length of the mobilized OA was 12.8 ± 1.2 cm, with a diameter of 1.3 ± 0.1 mm at the suboccipital segment and 1.1 ± 0.1 mm at the skin incision. On dry skulls, the occipitomastoid suture (OMS) was found to be medial to the OG in the majority of the cases (68.6%), making it a useful landmark to locate the OG and thus the proximal OA. CONCLUSIONS The anterograde transperiosteal inside-out approach for harvesting the OA is a fast and easy technique. It requires only superficial dissection because the OA is found directly under the periosteum throughout its course, obviating tedious layer-by-layer muscle dissection. This approach avoids critical neurovascular structures like the vertebral artery. The key landmarks needed to localize the OA using this technique include the OMS, OG, DM and DG, and SOM.
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Affiliation(s)
- Arnau Benet
- 1Department of Neurological Surgery, and.,2Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, California
| | - Halima Tabani
- 1Department of Neurological Surgery, and.,2Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, California
| | - Xinmin Ding
- 1Department of Neurological Surgery, and.,2Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, California
| | - Jan-Karl Burkhardt
- 1Department of Neurological Surgery, and.,2Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, California
| | - Roberto Rodriguez Rubio
- 1Department of Neurological Surgery, and.,2Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, California
| | - Ali Tayebi Meybodi
- 1Department of Neurological Surgery, and.,2Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, California
| | - Peyton Nisson
- 2Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, California
| | - Olivia Kola
- 2Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, California
| | - Sirin Gandhi
- 1Department of Neurological Surgery, and.,2Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, California
| | - Sonia Yousef
- 2Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, California
| | - Michael T Lawton
- 1Department of Neurological Surgery, and.,2Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, California
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18
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Abe H, Miki K, Kobayashi H, Ogata T, Iwaasa M, Matsushima T, Inoue T. Unilateral Trans-cerebellomedullary Fissure Approach for Occipital Artery to Posterior Inferior Cerebellar Artery Bypass during Aneurysmal Surgery. Neurol Med Chir (Tokyo) 2017; 57:284-291. [PMID: 28484132 DOI: 10.2176/nmc.oa.2016-0319if:2.036q3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
Occipital artery (OA) to the posterior inferior cerebellar artery (PICA) bypass is indispensable for the management of complex aneurysms of the PICA that cannot be reconstructed with surgical clipping or coil embolization. Although OA-PICA bypass is a comparatively standard procedure, the bypass is difficult to perform in some cases because of the location and situation of the PICA. We describe the usefulness of the unilateral trans-cerebellomedullary fissure (CMF) approach for OA-PICA bypass. Thirty patients with aneurysms in the vertebral artery (VA) or PICA were treated using OA-PICA bypasses between 2010 and 2015. Among them, the unilateral trans-CMF approach was used for OA-PICA anastomosis in 13 patients. The surgical procedures performed on and the medical records of all the patients were retrospectively reviewed. The unilateral trans-CMF approach was performed for two reasons depending on the PICA location or situation: either because the caudal loop could not be used as a recipient artery because of arterial dissection (3 patients) or because the tonsillo-medullary segment that was located in the upper part of the CMF did not have a caudal loop that was large enough (10 patients). The trans-CMF approach provided a good operative field for the OA-PICA bypass and the anastomosis were successfully performed in all patients. When the recipient artery was located in the upper part of the CMF, the unilateral trans-cerebello-medullary fissure approach provided a sufficient operative field for OA-PICA anastomosis.
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Affiliation(s)
- Hiroshi Abe
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University
| | - Koichi Miki
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University
| | | | - Toshiyasu Ogata
- Department of Neurology, Faculty of Medicine, Fukuoka University
| | | | | | - Tooru Inoue
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University
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19
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Abe H, Miki K, Kobayashi H, Ogata T, Iwaasa M, Matsushima T, Inoue T. Unilateral Trans-cerebellomedullary Fissure Approach for Occipital Artery to Posterior Inferior Cerebellar Artery Bypass during Aneurysmal Surgery. Neurol Med Chir (Tokyo) 2017; 57:284-291. [PMID: 28484132 PMCID: PMC5495960 DOI: 10.2176/nmc.oa.2016-0319] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Occipital artery (OA) to the posterior inferior cerebellar artery (PICA) bypass is indispensable for the management of complex aneurysms of the PICA that cannot be reconstructed with surgical clipping or coil embolization. Although OA-PICA bypass is a comparatively standard procedure, the bypass is difficult to perform in some cases because of the location and situation of the PICA. We describe the usefulness of the unilateral trans-cerebellomedullary fissure (CMF) approach for OA-PICA bypass. Thirty patients with aneurysms in the vertebral artery (VA) or PICA were treated using OA-PICA bypasses between 2010 and 2015. Among them, the unilateral trans-CMF approach was used for OA-PICA anastomosis in 13 patients. The surgical procedures performed on and the medical records of all the patients were retrospectively reviewed. The unilateral trans-CMF approach was performed for two reasons depending on the PICA location or situation: either because the caudal loop could not be used as a recipient artery because of arterial dissection (3 patients) or because the tonsillo-medullary segment that was located in the upper part of the CMF did not have a caudal loop that was large enough (10 patients). The trans-CMF approach provided a good operative field for the OA-PICA bypass and the anastomosis were successfully performed in all patients. When the recipient artery was located in the upper part of the CMF, the unilateral trans-cerebello-medullary fissure approach provided a sufficient operative field for OA-PICA anastomosis.
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Affiliation(s)
- Hiroshi Abe
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University
| | - Koichi Miki
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University
| | | | - Toshiyasu Ogata
- Department of Neurology, Faculty of Medicine, Fukuoka University
| | | | | | - Tooru Inoue
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University
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20
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Arning C, Pohlmann C, Arning K, Eckert B. [Not Available]. Praxis (Bern 1994) 2016; 105:1087-1090. [PMID: 27606916 DOI: 10.1024/1661-8157/a002461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Zusammenfassung. Wir berichten über eine 63-jährige Frau, die sich durch ein einseitiges Puls-synchrones Ohrgeräusch erheblich beeinträchtigt fühlte. Sämtliche bisher durchgeführte Diagnostik einschliesslich MRT und Gefässultraschall war unauffällig. Die Duplexsonografie mit Fokus auf die A. carotis externa zeigte nun jedoch eine verminderte Pulsatilität in der A. occipitalis, weniger deutlich in der A. carotis externa. Die Verdachtsdiagnose einer duralen AV-Fistel bestätigte sich angiografisch. Nach Embolisation der Fistel war die Patientin beschwerdefrei.
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Affiliation(s)
| | | | - Kathrin Arning
- 1 Praxis Neurologie und Neuro-Ultraschall, Hamburg-Rotherbaum
| | - Bernd Eckert
- 2 Institut für Radiologie und Neuroradiologie, Asklepios Klinik, Hamburg Altona
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Imahori T, Fujita A, Hosoda K, Kohmura E. Endovascular Internal Trapping of Ruptured Occipital Artery Pseudoaneurysm Associated with Occipital-Internal Jugular Vein Fistula in Neurofibromatosis Type 1. J Stroke Cerebrovasc Dis 2016; 25:1284-1287. [PMID: 26971039 DOI: 10.1016/j.jstrokecerebrovasdis.2016.02.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 01/11/2016] [Accepted: 02/06/2016] [Indexed: 11/18/2022] Open
Abstract
Spontaneous cervical extradural pseudoaneurysms or arteriovenous fistulas (AVFs) are rare vascular diseases. We report a case of ruptured occipital artery (OA) pseudoaneurysm associated with occipital-internal jugular vein (IJV) fistula in neurofibromatosis type 1. Endovascular internal trapping via the OA was attempted; however, the distal entry of the OA could not be accessed because of the high shunt flow and tortuosity of the OA. The distal part of the OA was obliterated with coil via a transvenous approach through the IJV and pseudoaneurysm. The proximal entry of the OA was obliterated with coil and glue under proximal flow control with a balloon, and the fistula was successfully obliterated without placement of coils in the pseudoaneurysm. When ordinary internal trapping via a transarterial approach is not possible, the transvenous approach should be considered as an alternative for AVF associated with an aneurysmal component.
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Affiliation(s)
- Taichiro Imahori
- Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Japan.
| | - Atsushi Fujita
- Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kohkichi Hosoda
- Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Eiji Kohmura
- Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Japan
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22
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Kaneko T, Tada Y, Maruya S, Takeishi E, Miura K, Masubuchi T, Fushimi C, Hasegawa H, Kamata S. Intra-arterial chemoradiation therapy with weekly low-dose cisplatin for squamous cell carcinoma of the maxillary sinus. Int J Oral Maxillofac Surg 2015; 44:697-704. [PMID: 25843537 DOI: 10.1016/j.ijom.2015.03.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 10/28/2014] [Accepted: 03/06/2015] [Indexed: 02/03/2023]
Abstract
A new intra-arterial chemoradiation regimen that involves infusing low-dose cisplatin in combination with definitive irradiation was used in 36 patients diagnosed with squamous cell carcinoma of the maxillary sinus. The safety and therapeutic efficacy of this regimen were reviewed retrospectively. An intra-arterial catheter was inserted in a retrograde manner into the target artery via the superficial temporal artery or occipital artery. Intra-arterial infusion was performed using cisplatin at a dose of 20-50mg/m(2) per week for 6-8 weeks. At the same time, sodium thiosulphate was infused as a neutralizing agent. Irradiation was performed at 60Gy in 30 fractions. All 36 patients completed treatment. Grade 3 adverse events occurred in only seven patients (19.4%) and no grade 4 events were noted. As a primary therapy, the complete response rate was 83.3%, the partial response rate was 16.7%, and the overall response rate was 100%. The 2-year local control rate was 63.0%, and the 2-year overall survival rate was 75.5%. The 2-year preservation rate of the hard palate was 97.1%, that of the eyeball was 97.2%, and that of visual function was 94.4%. This treatment regimen can contribute to improving the quality of life of patients without reducing the curability of the therapy.
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Affiliation(s)
- T Kaneko
- Head and Neck Oncology Centre, International University of Health and Welfare, Mita Hospital, Tokyo, Japan.
| | - Y Tada
- Head and Neck Oncology Centre, International University of Health and Welfare, Mita Hospital, Tokyo, Japan
| | - S Maruya
- Head and Neck Oncology Centre, International University of Health and Welfare, Mita Hospital, Tokyo, Japan
| | - E Takeishi
- Head and Neck Oncology Centre, International University of Health and Welfare, Mita Hospital, Tokyo, Japan
| | - K Miura
- Head and Neck Oncology Centre, International University of Health and Welfare, Mita Hospital, Tokyo, Japan
| | - T Masubuchi
- Head and Neck Oncology Centre, International University of Health and Welfare, Mita Hospital, Tokyo, Japan
| | - C Fushimi
- Head and Neck Oncology Centre, International University of Health and Welfare, Mita Hospital, Tokyo, Japan
| | - H Hasegawa
- Department of Dentistry and Oral Surgery, Fukushima Medical University, School of Medicine, Fukushima, Japan
| | - S Kamata
- Head and Neck Oncology Centre, International University of Health and Welfare, Mita Hospital, Tokyo, Japan
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23
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Katsuno M, Tanikawa R, Uemori G, Kawasaki K, Izumi N, Hashimoto M. Occipital artery-to-posterior inferior cerebellar artery anastomosis with multiple-layer dissection of suboccipital muscles under a reverse C-shaped skin incision. Br J Neurosurg 2015; 29:401-5. [PMID: 25633907 DOI: 10.3109/02688697.2015.1004300] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Although occipital artery (OA)-to-posterior inferior cerebellar artery (PICA) anastomosis is the most familiar reconstruction for posterior cerebral circulation, the procedure is considered difficult because of the anatomical complex course of OA and the depth of the operative field at the anastomosis site. Therefore, we attempted a safe and reliable method for OA-to-PICA anastomosis under multiple-layer dissection of suboccipital muscles and a reverse C-shaped skin incision. We reviewed the clinical records of patients who underwent OA-to-PICA anastomosis in our institute, and report the outcome with special emphasis on graft patency and surgical complications. Nine patients are described. In one patient the bypass was accomplished at the cortical segment of the PICA and in all others at the caudal loop. The average time for de-clamping the PICA was 29 min and 29 s. Although the overall graft patency rate was 100%, one patient showed a new medulla infarction at the time of post-operatory three-dimensional computed tomography angiography. Besides a secure OA-to-PICA anastomosis, this technique allows safe harvest of the OA and the creation of a shallow and wide anastomosis field.
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Affiliation(s)
- Makoto Katsuno
- Department of Neurosurgery, Abashiri Neurosurgical and Rehabilitation Hospital , Abashiri, Hokkaido , Japan
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Kishve PS, Kishve SP, Joshi M, Aarif SMM, Kalakoti P. An unusual branching pattern of common and external carotid artery in a human cadaver: a case report. Australas Med J 2011; 4:180-2. [PMID: 23393509 DOI: 10.4066/amj.2011.637] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
During a routine dissection in the Department of Anatomy of the Rural Medical College, Loni, we found a rare variation in branching pattern of the common carotid artery (CCA) and external carotid artery (ECA) bilaterally. The knowledge of possible anatomical variations of CCA and ECA are especially important in the surgeries of head, neck and face; and also for the radiologist to understand and interpret carotid system imaging when undertaking cerebral angiography. This case and the clinical significance of this variation are reported in this paper.
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Affiliation(s)
- Prajakta S Kishve
- Assistant Professor, Department of Anatomy, Loni, Maharashtra, India
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