The Occipitomastoid Suture As a Novel Landmark to Identify The

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The Occipitomastoid Suture as a Novel Landmark to Identify the Occipital Groove and Proximal Segment of the Occipital Artery

Halima Tabani MD; Sirin Gandhi MD; Roberto Rodriguez Rubio MD; Michael T. Lawton MD; Arnau Benet M.D.

University of California, San Francisco

Introduction
Results

Conclusions

The occipital artery (OA) is commonly used as a donor for posterior circulation bypass procedures. Localization of OA during harvesting is important to prevent inadvertent damage to the donor. The proximal portion of the OA is found in the occipital
In 71.5% of the specimens the OA ran in a groove, while it carved an impression in the rest of the cases (28.5%). In none of the specimens the OA was found to run in a bony canal. In 68.6% of the cases, the OMS was found to be medial to the OA

The OMS is a key landmark for localizing the proximal OA. The OMS can be followed inferiorly from the asterion to the OA groove, thereby localizing the proximal OA. Inadvertent damage to the proximal OA may be avoided by identifying the OMS and dissecting medial to it, since in majority of cases, the proximal OA will be located lateral to it

groove. The occipitomastoid suture (OMS) is located groove or impression while in 31.4%, it ran between the occipital bone and the mastoid portion of the temporal bone. This study aimed to assess the relationship between the OMS and the occipital groove, in order to facilitate localization of the proximal portion of OA while harvesting it for bypass centrally through the OA groove or impression (Figure 1). The OMS was never found lateral to the OA

Learning Objectives

1.To understand the relationship between the occipital groove and the occiptomastoid suture 2.To understand the potential use of occipitomastoid suture as a landmark to identify the proximal segment of OA in the occipital groove

Figure 1

Methods

Thirty-five dry skulls were assessed bilaterally (n=70) to study the bony landmarks that can be used to identify and locate the proximal segment of OA. The occipital groove (OG) was bilaterally identified in each skull and its shape was classified into canal, groove or impression. The asterion was located and the origin of OMS was identified. The OMS was then followed inferiorly to assess its relationship with the course of the OA (medial, lateral or central)

References

Dry skull images depicting the relationship between digastric groove, occipital groove, and occipito-mastoid suture (OMS).

1. Alvernia JE, Fraser K, Lanzino G: The occipital artery: a microanatomical study. Neurosurgery 58:ONS114-122; discussion ONS114-122, 2006 2. Ates O, Ahmed AS, Niemann D, Baskaya MK: The occipital artery for posterior circulation bypass: microsurgical anatomy. Neurosurg Focus 24:E9, 2008

(A) The morphologic configuration where the OMS is medial to the occipital groove is shown. The foramen for the mastoid emissary vein is also visible (B) The morphologic configuration where the OMS is running through the occipital groove is depicted. The asterion is shown; the OMS can be followed from the asterion inferiorly to locate the occipital groove, and thus, the OA

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