Division of Neurosurgery, Department of Surgery, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand.
Division of Neurosurgery, Department of Surgery, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand.
World Neurosurg. 2022 Jan;157:e364-e373. doi: 10.1016/j.wneu.2021.10.096. Epub 2021 Oct 18.
Occipital artery (OA)-posterior inferior cerebellar artery (PICA) bypass is a challenging procedure and is not frequently performed owing to the difficulty of OA harvest. To facilitate harvest, the intersection between the sternocleidomastoid and splenius capitis (the OA triangle) is used as the anatomical landmark to identify the OA segment that carries the highest risk of damage. This clinical study aimed to demonstrate efficacy and safety of OA harvest using this landmark.
The study included 18 patients who underwent OA harvest using the OA triangle as a landmark for treatment of vertebral artery and PICA aneurysms. Patients were retrospectively evaluated for safety and patency of OA after harvest and OA-PICA bypass.
Of 18 patients with ruptured and unruptured vertebral artery and PICA aneurysms, 13 (72.2%) underwent OA-PICA bypass and 5 (27.8%) did not undergo bypass. The OA was completely harvested without damage in all patients. After harvest, the OA was patent in 17 patients (94.4%) and was occluded in 1 patient owing to vasospasm; this patient then underwent recanalization resulting in good patency of the OA-PICA bypass. The patency rate of the OA-PICA bypass was 100%.
The OA triangle, which is the anatomical landmark of the proximal end of the transitional segment of the OA, facilitated OA harvest using the distal-to-proximal harvest technique with safety and good patency. To the best of our knowledge, this is the first study of OA harvest in clinical cases.
枕动脉（OA）-小脑后下动脉（PICA）旁路是一项具有挑战性的手术，由于 OA 血管采集的难度，其并不常进行。为了便于采集，胸锁乳突肌和头夹肌（OA 三角）的交点被用作解剖学标志，以确定携带最高损伤风险的 OA 段。本临床研究旨在展示使用该标志进行 OA 采集的有效性和安全性。
该研究纳入了 18 例使用 OA 三角作为解剖标志采集 OA 以治疗椎动脉和 PICA 动脉瘤的患者。对患者进行回顾性评估，以了解 OA 采集后的安全性和 OA-PICA 旁路的通畅性。
在 18 例破裂和未破裂的椎动脉和 PICA 动脉瘤患者中，13 例（72.2%）进行了 OA-PICA 旁路手术，5 例（27.8%）未进行旁路手术。所有患者均完整地采集了 OA，且没有造成损伤。采集后，17 例（94.4%）患者的 OA 是通畅的，1 例患者由于血管痉挛导致 OA 闭塞，该患者随后进行了再通，OA-PICA 旁路的通畅性良好。OA-PICA 旁路的通畅率为 100%。
OA 三角是 OA 过渡段近端的解剖学标志，使用远端到近端的采集技术，安全且 OA 具有良好的通畅性。据我们所知，这是首次对临床病例中的 OA 采集进行的研究。
