The Reseach Of The Occipital Artery Microsurgical Anatomy And Its Clinic Application

Objective 1.To observed the anatomical features of occipital and its adjacents in 15 cadavers,therefore provide anatomical bases for relevant operations such as far lateral approach,occipital artery-vertebral artery anastomosis and occipital arery-posterior inferior cerebellar artery anastomosis,and to discuss how to obtain the occipital artery effectively in the posterior circulation revascularation;3.Researched the clinical data of the patients having achieved operations using occipital artery as the donor vessel,to provide the references for the clinical treatment.Methods 1 Using 15(30sides)adult cadaveric heads perfused with colored silicone,the occipital artery and its relavants were anatomied,especially the course,diameter,branches,variations,supplying area,anastomosis with other vessels and relationship with the transverse process of the atlas,SNL,and the external occipital protuberance.2,Far lateral approach was used in 15 cadaveric heads,discussed how to protect the posterior cranial nerves in this approach for anastomosis of occipital artery-vertebral artery,occipital artery-posterior inferior cerebellar artery,and photographed them;3 Observatied,measured and recorded the 15 patients used occipital artery as donor vessels on the postior bypass operation and its characteristics of postoperative and preoperative DSA and ultrasonic Doppler.Results 1 The occipital artery at the two abdominal ventral posterior inferior originated from external carotid artery wall or the outer wall,and accompanied by greater occipital nerve,continued to uplink to the scalp in the superficial fascia,and separated one or two terminal or distal branches distributing on the scalp.The diameter of starting point of the occipital artery was(2.3±0.3)mm,the length of the occipital artery which paralleled to the superior border of transverse process and crossed the superior nuchal line was(93.2±2.6)mm,and the outer diameter of vertebral artery which paralleled to the superior border of transverse process was(1.9±0.4)mm,the outer diameter of vertebral artery which crossed the superior nuchal was(1.8±0.3)mm.The mid-point diameter of V3 segment of vertebral artery was(3.2±1.4)mm,the distance from occipital artery to the external occipital protuberance was(23.7±1.2)mm,and the maximal distance from occipital artery to superior nuchal line was(21.4±0.9)mm.2 In the operation of posterior circulation bypass taking occipital artery as donor vessel in,using photos to record how to recieve the occiptal artery and picture in operation.Statisticed the velocity and diameter under the color Doppler of the patients preoperation.Conclusion1.The effective length of the occipital artery for transplantation is:from the point parallel to the superior margin of the C1 transverse process to the point cross the SNL.According to the route,adjacents,diameter and flow under the DSA and color Doppler.It is possibal to remiss the posterior circulational ischemia after the operation of occipital artery-vertebral artery bypass.2.It is safe and effective for obtaining the occipital artery to take external occipital protuberance,superior nuc line,tip of mastoid process,transverse process of the atlas as anatomic landmark.3.Using occipital artery as donor artery in occipital artery-vertebral artery bypass operation,bone flaping is not necessary,the difficulty is to separate the occipital muscles and hemostasis,especially internal vertebral venous plexus in the occipital triangle.4.Using occipital artery as donor artery in occipital artery-posterior inferior cerebellar artery bypass surgery,choosed the medulla oblongata cerebellar-tonsillar segment as the receiving segment,can reduce intraoperative cranial nerve harassment,thereby reducing surgery complications.