An Orientational Harvesting Occipital Artery Technique via far Lateral Approach: A Cadaveric Study

To provide further information on the identification of the occipital artery (OA) and suggest an improved approach to its anterograde dissection technique for harvesting.

Six cadaveric specimens were prepared for surgical simulation, and the anterograde approach was used to harvest the OA; a hockey stick incision was made from the C2 spinous process through the nuchal ligament to the mastoid tip. By retracting the scalp flap from the posterior arch of C2 to the transverse process, the suboccipital triangle was reflected by a single myocutaneous flap from the inferior nuchal line. In addition, 70 head computed tomography angiography scans were assessed bilaterally (n = 140) to study the running pattern of the OA.

The mean total length of the mobilized OA was 11.8 ± 0.7 cm, with a diameter of 1.5 ± 0.1-2.1 ± 0.2 mm at the suboccipital segment and 1.3 ± 0.1 mm at the upper edge of the surgical incision. The average distance of OA at the inferior nuchal line to the midline was 2.9 ± 0.3 cm, the average distance of OA at the superior nuchal line to midline was 4.1 ± 0.2 cm, the average distance of OA at incision edge to midline was 5.2 ± 0.3 cm.

Orientational anterograde technique for OA harvesting is a fast and easy approach. This approach avoids critical neurovascular structures. The most important step is to identify the OA near the lateral edge of the superior oblique muscle. Subsequently, in conjunction with preoperative computed tomography angiography, an imaginary line that crosses the inferior and superior nuchal lines may be established to assist in the separation of the OA.