• Lorenzo Rinaldo, Rodriguez RubioRobertoRDepartment of Neurosurgery, University of California San Francisco, San Francisco, California, USA; Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, California, USA; Department of Otolaryngology - , and Adib A Abla.
• Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA.
• World Neurosurg. 2023 Dec 1; 180: 374137-41.

BackgroundThe distal suboccipital segment of the occipital artery is commonly used as a donor vessel for aneurysms of the posterior circulation requiring revascularization techniques. Isolating this segment of vessel can be challenging due to its course in and out of the various layers of the suboccipital musculature.MethodsWe describe the use of the proximal suboccipital segment of the occipital artery within the occipital groove at the lateral skull base as a donor segment for an interposition graft in revascularization surgery. We present a case detailing the use of this technique for treatment of a dissecting PICA aneurysm and photographs from cadaveric dissections demonstrating relevant anatomy.ResultsOur patient is a 62-year-old man who presented with a high-grade subarachnoid hemorrhage from a proximal dissecting-type aneurysm of the posterior inferior cerebellar artery (PICA). Endovascular options were limited to coil sacrifice of the parent vessel, and thus the patient was taken for a far lateral craniotomy, trapping of the aneurysm, and revascularization of the PICA territory via a saphenous vein interposition graft sewn proximally and distally to the occipital artery within the occipital groove and a cortical segment of the affected PICA, respectively. Postoperative imaging demonstrated filling of the PICA territory via the graft, and the patient ultimately recovered from his subarachnoid hemorrhage.ConclusionsThe use of the proximal suboccipital segment of the occipital artery is a viable option for a donor in posterior fossa revascularization surgery.Copyright © 2023 Elsevier Inc. All rights reserved.

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