Single midline incision approach for decompression of greater, lesser and third occipital nerves in migraine surgery

Abstract

Background The traditional approach for occipital migraine surgery encompasses three separate surgical incisions in the posterior neck to decompress the greater occipital nerves (GON), lesser occipital nerves (LON), and third occipital nerves (TON). Other incisions have been investigated, including singular transverse incisions. We sought to evaluate a single, vertical midline incision approach for decompression of all six occipital nerves. Methods Using 10 cadaveric hemi-sides (5 fresh cadaver head and necks). Anatomic landmarks and the location of the bilateral GON, LON, and TON were marked according to previous anatomic studies. A single, midline 9-cm incision was made, and lateral skin flaps were raised to decompress or avulse all six nerves. Results Through the midline incision, the GON and TON were identified at 3.5 and 6.2 cm, respectively, inferior to a line bisecting the external auditory canal (EAC) and 1.5 cm lateral to the midline. The LON was identified as 6-cm inferior and 6.5-cm medial to a line bisecting the EAC in the plane just above the investing layer of the deep cervical fascia until the posterior border of the sternocleidomastoid was encountered. The LON had the greatest amount of variation but was identified lateral to the posterior border of the SCM. Conclusions A single midline incision approach allows for successful identification and decompression of all six occipital nerves in migraine surgery.

Consideraciones Anátomo-Funcionales del Nervio Occipital y sus Implicancias Fisiopatológicas.

“…El nervio suboccipital emerge del canal central de la médula espinal y viaja inferiormente entre el hueso occipital y superiormente al arco posterior de la vértebra C1, es decir el Atlas. 10 En el camino, el nervio suboccipital viaja muy cerca de la arteria vertebral. Por lo tanto, en los Fundamentos bioestructurales de neurociencias ISSN: 1850 -4485 ISSN: 1850 -4485 casos de lesiones de la arteria vertebral en alguna zona vecina región conocida como aquella del triángulo suboccipital, es probable que también se lesione el nervio suboccipital.…”