TY - JOUR
T1 - The Greater Occipital Nerve and Its Dynamic Compression Points
T2 - Implications in Migraine Surgery
AU - Chung, Michael
AU - Lu, Karen B.
AU - Sanniec, Kyle
AU - Amirlak, Bardia
N1 - Publisher Copyright:
© 2022 Lippincott Williams and Wilkins. All rights reserved.
PY - 2022/6/1
Y1 - 2022/6/1
N2 - Background: The greater occipital nerve is a common compression site for migraine or chronic headache, and variable relationships with the occipital artery have been shown in anatomical studies. Despite surgical decompression, there are still a subset of patients who have an incomplete response. In this article, the authors describe an observed clear and very consistent pattern between the nerve and artery, including both dynamic and static compression points, that must be evaluated for adequate treatment. Methods: Seventy-one patients underwent occipital nerve decompression with high-definition videos and photographs, and the dynamic relationship between the greater occipital nerve and the occipital artery was recorded in a retrospective review. Results: A consistent pattern existed in 92 percent of patients, as follows: (1) hidden proximal dynamic compression of the bottom surface of the nerve as the occipital artery comes laterally to dive under the greater occipital nerve; (2) more apparent dynamic compression on the upper surface of the nerve as the occipital artery loops back on top of the greater occipital nerve; (3) intertwining compression after the bifurcation of the greater occipital nerve as the artery wraps around the medial branch; and (4) parallel travel of the terminal branch of the greater occipital nerve with the occipital artery in close proximity. Conclusions: There is a consistent pattern in the relationship between the greater occipital nerve and the occipital artery after its exit from the trapezius fascia. It is possible that this relationship creates dynamic compression points, including hidden areas, that can only be deactivated by radical excision of the vessel.
AB - Background: The greater occipital nerve is a common compression site for migraine or chronic headache, and variable relationships with the occipital artery have been shown in anatomical studies. Despite surgical decompression, there are still a subset of patients who have an incomplete response. In this article, the authors describe an observed clear and very consistent pattern between the nerve and artery, including both dynamic and static compression points, that must be evaluated for adequate treatment. Methods: Seventy-one patients underwent occipital nerve decompression with high-definition videos and photographs, and the dynamic relationship between the greater occipital nerve and the occipital artery was recorded in a retrospective review. Results: A consistent pattern existed in 92 percent of patients, as follows: (1) hidden proximal dynamic compression of the bottom surface of the nerve as the occipital artery comes laterally to dive under the greater occipital nerve; (2) more apparent dynamic compression on the upper surface of the nerve as the occipital artery loops back on top of the greater occipital nerve; (3) intertwining compression after the bifurcation of the greater occipital nerve as the artery wraps around the medial branch; and (4) parallel travel of the terminal branch of the greater occipital nerve with the occipital artery in close proximity. Conclusions: There is a consistent pattern in the relationship between the greater occipital nerve and the occipital artery after its exit from the trapezius fascia. It is possible that this relationship creates dynamic compression points, including hidden areas, that can only be deactivated by radical excision of the vessel.
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U2 - 10.1097/PRS.0000000000009094
DO - 10.1097/PRS.0000000000009094
M3 - Article
C2 - 35383686
AN - SCOPUS:85173535061
SN - 0032-1052
VL - 149
SP - 1321
EP - 1324
JO - Plastic and reconstructive surgery
JF - Plastic and reconstructive surgery
IS - 6
ER -