Emrah ÖZCAN, Esma DERİNÖZ, Bahar KEYİK, Ömür KARACA, Tuğba GİRGİN, İlter KUŞ, Alper VATANSEVER

Arteria Occipitalis’in Morfometrik Değerlendirilmesi

Amaç: Nervus occipitalis major blokajı sırasında, bu sinir ile yakın komşuluk yapan arteria occipitalis’te oluşabilecek komplikasyonları en aza indirgemek için arteria occipitalis anatomisinin iyi bilinmesi gerekir. Bu çalışmada; arteria occipitalis’in klinik uygulamalar sırasında zarar görmesini önleyebilmek adına, komşu anatomik yapılarla olan morfometrik ilişkisinin değerlendirilmesi amaçlanmaktadır. Gereç ve Yöntem: Bu çalışma, Balıkesir Üniversitesi Tıp Fakültesi Eğitim ve Araştırma Hastanesi’ne 2015-2021 yılları arasında çeşitli sebeplerle başvuran hastaların baş-boyun bölgesine ait BTA görüntüleri kullanılarak gerçekleştirildi. Araştırmada; 35-63 yaşları arasındaki toplam 85 bireyin BTA görüntüleri Radiant DICOM viewer 64-bit bilgisayar yazılımı kullanılarak morfometrik olarak değerlendirildi. Elde edilen veriler SPSS Versiyon 25 yazılımına aktarılarak kantitatif olarak analiz edildi. Bulgular: Çalışmadan elde edilen sonuçlara göre; değişkenler ile cinsiyetler arasında anlamlı bir fark tespit edilmedi. Bireyin yaşının artmasıyla sol arteria occipitalis’in, protuberantia occipitalis externa’nın daha inferolateralinde yer aldığı görüldü. Elde edilen veriler sonucunda, sağ AO-MH ve sağ POE-MH arasındaki en yakın mesafe ile yedinci servikal vertebra’nın processus spinosus’u arasında negatif bir korelasyon gözlendi. Sonuç: Sonuç olarak; elde edilen ortalama değerler doğrultusunda, posterior oksiputta referans alınan işaret noktalarının birleştirilmesi sonucu oluşan üçgen sahanın merkez noktasına yapılacak bir enjeksiyonun, arteria occipitalis’i korumak adına daha güvenli olabileceği düşünülmektedir.

Anahtar Kelimeler:

Arteria Occipitalis, Güvenli Bölge, Morfometri.

Morphometric Evaluation of Occipital Artery

Objective: Occipital artery anatomy should be well known in order to minimize complications that may occur in the occipital artery, which is closely adjacent to this nerve, during greater occipital nerve blockade. In this study, it is aimed to evaluate the morphometric relationship of the occipital artery with neighboring anatomical structures in order to prevent damage during clinical applications. Materials and Methods: This study was carried out using CTA images of the head and neck region of patients who applied to Balikesir University Medical Faculty Training and Research Hospital for various reasons between 2015 and 2021. In the study, CTA images of 85 individuals aged 35-63 years were evaluated morphometrically using Radiant DICOM viewer 64-bit computer software. The obtained data were transferred to SPSS Version 25 software and analyzed quantitatively. Results: According to the results obtained from the study, no significant difference was found between the variables and genders. As the age of the individual increased, it was observed that the left occipital artery was located more inferolateral to the external occipital protuberance. As a result of the data obtained, a negative correlation was observed between the closest distance between the right OA-ML and the right EOP-ML and the spinous process of the seventh cervical vertebra. Conclusion: In line with the average values obtained as a result, it is thought that an injection to the central point of the triangular area, which is formed as a result of combining the reference points in the posterior occiput, may be safer in order to protect the occipital artery.

Keywords:

Occipital Artery Safe Zone, CTA, Morphometry.,

PDF

___

Arıncı, K., Elhan, A. Anatomi, 1. Cilt, Güneş Kitabevi, Ankara, 2014.
Becser, N., Bovim, G., Sjaastad, O. (1998). Extracranial nerves in the posterior part of the head: anatomic variations and their possible clinical significance. Spine, 23(13), 1435-41. https://doi.org/10.1097/00007632-199807010-00001.
Dash, KS., Janis, JE., Guyuron, B. (2005). The lesser and third occipital nerves and migraine headaches. Plast Reconstr Surg, 115, 1752-8. https://doi.org/10.1097/01.prs.0000161679.26890.ee.
Elhammady, M.S., Telischi, F.F., Morcos, J.J. (2012). Retrosigmoid approach: indications, techniques, and results. Otolaryngol Clin North Am, 45, 375-397. https://doi.org/10.1016/j.otc.2012.02.001.
George, D., & Mallery, M. (2010). SPSS for Windows Step by Step: A Simple Guide and Reference, 17.0 update (10a ed.) Boston: Pearson.
Gille, O., Lavignolle, B., Vital, JM. (2004). Surgical treatment of greater occipital neuralgia by neurolysis of the greater occipital nerve and sectioning of the inferior oblique muscle. Spine, 29(7), 828-32.
Hecht, JS. (2004). Occipital nerve blocks in postconcussive headaches. A retrospective review and report of ten patients. Journal of Head Trauma Rehabilitation, 19(1), 58-71. https://doi.org/10.1097/00001199-200401000-00006
Inan, LE., Inan, N., Unal-Artık, HA., Atac, C., Babaoglu, G. (2019). Greater occipital nerve block in migraine prophylaxis: Narrative review. Cephalalgia, 39(7), 908-920. https://doi.org/10.1177/0333102418821669
Inoue, Y., Matsuzawa, K. (2019). Occipital Artery-to-Vertebral Artery Bypass to Stop Transient Ischemic Attacks Caused by Traumatic Vertebral Artery Dissection. World Neurosurgery, 123, 64-66. https://doi.org/10.1016/j.wneu.2018.11.220 Keser, N., Avci, E., Soylemez, B., Karatas, D., Baskaya, MK. (2018). Occipital Artery and Its Segments in Vertebral Artery Revascularization Surgery: A Microsurgical Anatomic Study. World Neurosurgery, 112, 534-539.
Kimura, T., Morita, A. (2017). Occipital Artery to Middle Cerebral Artery Bypass: Operative Nuances. World Neurosurg, 108, 201-205.
La Rocca, G., Altieri, R., Ricciardi, L., Olivi, A., Della Pepa, G.M. (2017). Anatomical study of occipital triangles: the “inferior” suboccipital triangle, a useful vertebral artery landmark for safe postero-lateral skull base surgery. Acta Neurochir (Wien), 159, 1887-1891. Leinisch-Dahlke, E., Jürgens, T., Bogdahn, U., Jakob, W., May, A. (2005). Greater occipital nerve block is ineffective in chronic tension type headache. Cephalalgia, 25, 704-8.
Loukas, M., El-Sedfy, A., Tubbs, RS., Louis, Jr. RG., Wartmann, ChT., Curry, B. et al. (2006). Identification of greater occipital nerve landmarks for the treatment of occipital neuralgia. Folia Morphologica, 65(4), 337–42.
Maughan, P.H., Ducruet, A.F., Elhadi, A.M., Martirosyan, N.L., Garrett, M., Mushtaq, R. et al. (2013). Multimodality management of vertebral artery injury sustained during cervical or craniocervical surgery. Neurosurgery, 73, 271-281. Natsis, K., Baraliakos, X., Appell, HJ., Tsikaras, P., Gigis, I., Koebke, J. (2006). The course of the greater occipital nerve in the suboccipital region: a proposal for setting landmarks for local anesthesia in patients with occipital neuralgia. Clinical Anatomy, 19, 332-6. https://doi.org/10.1002/ca.20190
Palamar, D., Uluduz, D., Saip, S. et al. (2015). Ultrasound-guided greater occipital nerve block: An efficient technique in chronic refractory migraine without aura? Pain Physician Journal, 18, 153–162.
Scattoni, L., Di Stani, F., Villani, V., Dugoni, D., Mostardini, C., Reale, C. et al. (2006). Great occipital nerve blockade for cluster headache in the emergency department: case report. J Headache Pain, 7, 98-100.
Shimizu, S., Oka, H., Osawa, S., Fukushima, Y., Utsuki, S., Tanaka, R. et al. (2007). Can proximity of the occipital artery to the greater occipital nerve act as a cause of idiopathic greater occipital neuralgia? An anatomical and histological evaluation of the artery–nerve relationship. Plastic and Reconstructive Surgery, 119, 2029-34. https://doi.org/10.1097/01.prs.0000260588.33902.23
Standring, S. editor-in-chief. Gray’s anatomy the anatomical basis of clinical practice. 39th ed. Amsterdam: Elsevier; 2005.
Tubbs, RS., Salter, EG., Wellons III, JC., Blount, JP., Oakes, WJ. (2007). Landmarks for the identification of the cutaneous nerves of the occiput and nuchal regions. Clinical Anatomy, 20, 235-8. https://doi.org/10.1002/ca.20297.