{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T04:23:06Z","timestamp":1772770986700,"version":"3.50.1"},"reference-count":13,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,1]]},"abstract":"<jats:sec><jats:title>OBJECTIVE<\/jats:title><jats:p>The occipital artery (OA) is a frequently used donor vessel for posterior circulation bypass procedures due to its proximity to the recipient vessels and its optimal caliber, length, and flow rate. However, its tortuous course through multiple layers of suboccipital muscles necessitates layer-by-layer dissection. The authors of this cadaveric study aimed to describe a landmark-based novel anterograde approach to harvest OA in a proximal-to-distal \u201cinside-out\u201d fashion, which avoids multilayer dissection.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>Sixteen cadaveric specimens were prepared for surgical simulation, and the OA was harvested using the classic (n = 2) and novel (n = 14) techniques. The specimens were positioned three-quarters prone, with 45\u00b0 contralateral head rotation. An inverted hockey-stick incision was made from the spinous process of C-2 to the mastoid tip, and the distal part of the OA was divided to lift up a myocutaneous flap, including the nuchal muscles. The OA was identified using the occipital groove (OG), the digastric muscle (DM) and its groove (DG), and the superior oblique muscle (SOM) as key landmarks. The OA was harvested anterogradely from the OG and within the flap until the skin incision was reached (proximal-to-distal technique). In addition, 35 dry skulls were assessed bilaterally (n = 70) to study additional craniometric landmarks to infer the course of the OA in the OG.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>The OA was consistently found running in the OG, which was found between the posterior belly of the DM and the SOM. The mean total length of the mobilized OA was 12.8 \u00b1 1.2 cm, with a diameter of 1.3 \u00b1 0.1 mm at the suboccipital segment and 1.1 \u00b1 0.1 mm at the skin incision. On dry skulls, the occipitomastoid suture (OMS) was found to be medial to the OG in the majority of the cases (68.6%), making it a useful landmark to locate the OG and thus the proximal OA.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>The anterograde transperiosteal inside-out approach for harvesting the OA is a fast and easy technique. It requires only superficial dissection because the OA is found directly under the periosteum throughout its course, obviating tedious layer-by-layer muscle dissection. This approach avoids critical neurovascular structures like the vertebral artery. The key landmarks needed to localize the OA using this technique include the OMS, OG, DM and DG, and SOM.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2017.6.jns17518","type":"journal-article","created":{"date-parts":[[2018,1,26]],"date-time":"2018-01-26T15:00:19Z","timestamp":1516978819000},"page":"207-212","source":"Crossref","is-referenced-by-count":24,"title":["The transperiosteal \u201cinside-out\u201d occipital artery harvesting technique"],"prefix":"10.3171","volume":"130","author":[{"given":"Arnau","family":"Benet","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery, and"},{"name":"Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Halima","family":"Tabani","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, and"},{"name":"Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xinmin","family":"Ding","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, and"},{"name":"Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jan-Karl","family":"Burkhardt","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, and"},{"name":"Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roberto","family":"Rodriguez Rubio","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, and"},{"name":"Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ali","family":"Tayebi Meybodi","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, and"},{"name":"Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peyton","family":"Nisson","sequence":"additional","affiliation":[{"name":"Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Olivia","family":"Kola","sequence":"additional","affiliation":[{"name":"Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sirin","family":"Gandhi","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, and"},{"name":"Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sonia","family":"Yousef","sequence":"additional","affiliation":[{"name":"Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael T.","family":"Lawton","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, and"},{"name":"Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, California"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"b1","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"1275","DOI":"10.3171\/2015.5.JNS15368","article-title":"Intracranial-to-intracranial bypass for posterior inferior cerebellar artery aneurysms: options, technical challenges, and results in 35 patients","volume":"124","author":"Abla AA","year":"2016","unstructured":"Abla AA, McDougall CM, Breshears JD, Lawton MT: Intracranial-to-intracranial bypass for posterior inferior cerebellar artery aneurysms: options, technical challenges, and results in 35 patients. 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