Reconstruction of anterior inferior cerebellar artery by occipital artery through extended retrosigmoid approach / 中华显微外科杂志

Objective To explore the feasibility of occipital artery(OA) to anterior inferior cerebellar artery (AICA) through the extended retrosigmoid approach,also perform a systemic microanatomical study of OA and AICA with the exposure of extended retrosigmoid approach,find the easy way to perform the procedure.Methods From September,2016 to January,2017,5 adult cadaveric heads injected with colored latex (total 10 sides) were performed the extended retrosigmoid approach,and measured the caliber of distal occipital artery (OA),the final length of the OA harvest,the reliable landmark of the OA harvest,and the distance from the flocculonodular segment of anterior inferior cerebellar artery (AICA) to the OA,the diameter of AICA flocculonodular segment branch.Whole procedure of OA to IACA bypass also be performed.Statistical analysis was performed.Results By the extended retrosigmoid approach,AICA flocculonodular segment could be easily exposure,the average diameter was 1.2 mm,the OA branch could be harvested in average was (72.3±3.3)mm in length from the occipital sulcus,and the average distance between occipital sulcus and AICA flocculonodular segment was (47.6±l.9)mm.The bypass procedure also could be performed through the proper corridor.Conclusion The Extended retrosigmoid approach is a safe and efficient way to perform the OA-AICA bypass procedure,and the procedure is easier to be performed than other surgical approaches.

Anatomy of occipital artery through far lateral approach and its nuance in vessel bypass of posterior circulation / 中华神经医学杂志

Objective To observe the anatomical course of occipital artery through far lateral approach and make preparation for posterior circulation vascular bypass operation.Methods Far lateral approach was performed to observe the 20 occipital arteries in 10 cadaveric heads with color silicon glue perfusion.The origin,course branches,adjacent structure and diameter of related segments were observed and measured.The distance from the adjacent structures and the diameter of vertebral arteries were measured at the same time.The anatomical structures were recorded by taking photos.Results The occipital artery originated from posterior wall of external carotid artery at the level of mandibular angle and raised up between medial to external carotid artery and lateral to Jugular vein.Then it coursed to posteriorlateral direction,raising up between digastric posterior belly and rectus capitis lateralis,going up digastric posterior belly and superior oblique muscle.And then,it crossed longus scapitis on or beneath its surface and coursed medially on the surface of superior oblique muscle and semispinalis capitis muscle below the superior nuchal line.The occipital artery crossed up the superior nuchal line where trapezius muscle and semispinalis capitis muscle attached,accompanied with greater occipital nerve.And then,it outgrew 1 or 2 branches distributing the distal scalp beneath the superficial fascia of scalp.The diameter of occipital artery was (2.4±0.4) mm,(2.0±0.2) mm,(1.7±0.1) mm at the original point,superior border of transverse process and superior nuchal line,respectively.The length of occipital artery fiom point of superior border of transverse process to the point of superior nuchal line was (93.3±2.4) mm,from the point of superior nuchal line to external occipital protuberance was (21.6±0.8)mm.Diameter of the midpoint of V3 segment of vertebral artery was (3.3±1.3) mm.Conclusions The far lateral approach focusing on the vertebral artery could expose the course of occipital artery,vertebral artery,and atlas-occipital junction widely.The occipital artery could locate the position by mastoidale,digastric posterior belly,and transverse process of atlas.Its diameter and length are suitable for vessel bypass of posterior circulation.

Treatment of vertebrobasilar aneurysms using suboccipital muscle stratification via far lateral approach / 中国脑血管病杂志

Objective To discuss the technical essentials of microsurgery using suboccipital muscle stratification for the treatment of complex vertebrobasilar aneurysms via far lateral approach.Methods The clinical data of 8 patients with vertebrobasilar aneurysm underwent suboccipital muscle stratification via far lateral approach at the Department of Neurosurgery,Xuanwu Hospital,Capital Medical University were analyzed retrospectively,including 5 patients with subarachnoid hemorrhage (Hunt-Hess grade Ⅱ 3 cases;grade Ⅲ 1 case;grade Ⅳ 1 case),and 3 with symptomatic dissecting aneurysm.Six patients underwent occipital artery-posterior inferior cerebellar artery and anterior inferior cerebellar artery bypass grafting,and aneurysm trapping,and the aneurysms of the other 2 cases were clipped directly in the operation.The modified Rankin scale (mRS) was used to evaluate the clinical efficacy.Results Postoperative digital subtraction angiography (DSA) revealed that all the bridge vessels were patent.The obtained length of occipital artery in the actual measurement of the operation was 12.5±1.1 cm.The distance between the anastomosis site and the skin incision in 6 cases was 50±6 mm.They were followed up for 4-21 months after procedure.The mRs score in 7 cases was 0-1.Two patients had new-onset hoarseness and recovered completely within 3 months after procedure.Another patient had postoperative cerebellar hemisphere dominant regional cerebral infarction and the mRs score was 4.None of them had poor wound healing,infection and cerebrospinal fluid leakage after procedure.Conclusion Suboccipital muscle stratification via far lateral approach can effectively obtain a longer occipital artery,reduce the occupation effect of muscle and depth of field.It is beneficial to expose lesions and operation of deep anastomosis.It is a more safe and practical technique in neurosurgery for the treatment of vertebrobasilar artery aneurysms.

A Rare Case of Spontaneous True Aneurysm of the Occipital Artery

A 51-year-old man presented with a pulsatile scalp mass over the right occipital region, which had increased in size over the previous 1 month. He had no previous history of head trauma. Three-dimensional computed tomography (3D-CT) angiography of the brain revealed a 3.0 x 1.5 cm occipital artery aneurysm arising from the occipital artery. The occipital artery aneurysm was removed following the ligation of the proximal and distal portion of the occipital artery aneurysm. The histological diagnosis was true aneurysm. To the best of our knowledge, this is the first reported case in the literature.

Epidural Hematomas due to Occipital Artery Injury Following Ventriculoperitoneal Shunt and Extraventricular Drainage

Ventriculoperitoneal (VP) shunt is a common treatment for hydrocephalic patients. However, complications, such as shunt tube occlusion, infection, intracranial hemorrhage, seizure can occur. Of these, intracranial hemorrhage may occur due to intracranial vascular injury or a rapid decrease of intracranial pressure (ICP). Most of these hemorrhages are subdural hematomas (SDH) while a few are epidural hematomas (EDH). It is extremely rare for an intracranial hemorrhage to occur due to an extension of the bleeding from an injured extracranial vessel. We report two cases of EDH due to occipital artery injury following VP shunt and extraventricular drainage (EVD).

Traumatic Aneurysm of the Occipital Artery: Case Report

Reported below is a case of traumatic aneurysm of the occipital artery. A 17-year-old man was referred to our hospital with a 2x2x1 cm sized pulsatile mass in the left occipital area which had progressively increased in size during the 25 days after blunt trauma. External carotid angiogram revealed a aneurysm of the left occipital artery. The occipital artery was ligated proximal and distal to the aneurysm and the aneurysm was removed. Pathological examination confirmed a partially thrombosed pseudoaneurysm.

Spontaneous Occipital Artery Aneurysm: A Case Report

The authors presented an unusual case of an occipital artery aneurysm which developed spontaneously. The patient was a 41-year-old woman who suffered from the sudden onset of right hemiparesis and slurred speech. Computerized tomography scans of the brain demonstrated an intracerebral hemorrhage in the left parietal lobe. The carotid angiography revealed an incidental saccular aneurysm in the left occipital artery. The aneurysm was not treated because the patient's relatives refused operation and there were no subjective complaints by the patient. Certain particularities of this lesion are discussed in the context of the literature.