Introduction: The occipital artery (OA) is an important donor artery for posterior fossa revascularization. In contrast to the superficial temporal artery (STA), which runs in the same vertical layer all the way, harvesting the OA is believed to be difficult and time-consuming due to its 3-dimensional course through different suboccipital muscle layers.
Methods: Using five preserved cadaveric heads (10 sides) previously injected with colored latex, the course of OA was explored and safe and effective means of dissection from surrounding tissue was proposed. The OA was divided into two segments based on the vertical layer it runs through, subgaleal and submuscular, and each was examined separately.
Results: We divided the OA into two compartments, subgaleal and submuscular, which were approximately correspondent with the terminal and suboccipital segments, respectively. In the subgaleal segment, the OA ran above the galea in a single vertical layer, and was dissected out of surrounding fat tissues in a similar manner to the STA. In the submuscular segment, the OA appears to run through different muscle layers, however once the suboccipital muscles were properly detached and retracted, the OA was found to run along a single vertical layer of connective tissue. Harvesting the OA from this fat-rich layer was comparable in difficulty to harvesting the STA. The transition point, where the subgaleal OA goes into the posterior edge of splenius capitus muscle and becomes the submuscular segment, was located approximately 1 cm below superior nuchal line and was safely detected by flipping over skin flap from lateral to medial.
Conclusions: Although the course of OA is complex, precise anatomical knowledge of the suboccipital muscles and a stepwise dissection makes harvesting the OA relatively simple.
Patient Care: This technique will enhance the surgeons understanding of a safe and effective technique used to harvest the occipital artery and reduce operative time.
Learning Objectives: By the conclusion of this session, participants should be able to understand (1) the anatomy of the occipital artery and (2) how to safely harvest it surgically.