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The Role of the Third Occipital Nerve (TON) in Surgical Treatment of Occipital Migraine Headaches
Michelle Lee MD, Deborah Reed MD, Kyle Lineberry MD Bahman Guyuron MD
2013-02-15
Presenter: Kyle Lineberry MD
Affidavit:
Work not published or accepted in any journal at this time. Michelle Lee MD and Deborah Reed MD were involved in data collection,initial manuscript and preparation of presentation. Presenting resident (Lineberry) is participant in writing final manuscript and presenting results. All work is orginal work from the deparment of plastic surgery at Case Western/University Hospitals residency program. All residents and staff involved have agreed to presentation at OVSPS meeting.
Director Name: Hooman Soltanian MD
Author Category: Resident Plastic Surgery
Presentation Category: Basic Science Research
Abstract Category: Aesthetics
BACKGROUND: The third occipital nerve (TON) is often encountered during occipital migraine surgery. If encountered during MH surgery it is typically sacrificed. Little evidence exists correlating the sacrifice of the TON and success of surgery. The objective of this study was to determine whether sacrifice of the TON is associated with a significant difference in surgical outcomes.
METHODS: A retrospective review was conducted on all occipital MH (Site IV) patients from 1/2000 to 12/2010. Inclusion criteria were: 1)migraine Site IV decompression , 2)completion of migraine questionnaire , and 3) minimum 6 months of follow-up. Patients were divided into those who had the third occipital nerve removed (TON R) and those who did not (TON NR). Outcome variables were anlyzed using t test
RESULTS: 229 patients were included. The TON R group (111 patients) and the TON NR (118 patients) were well matched regarding demographics and baseline symptoms. When the TON R group were compared to the TON NR group MH index reduction was 63% versus 64%. Patients experiencing MH elimination (TON R 26 % vs. TON NR 29%; p= 0.45) and surgery success, defined as at least a 50% reduction in number of MH (TON R 80% vs. TON NR 81%; p=0.82) were also similar. There was also no significant difference between the two groups in symptomatic neuroma formation. Site IV specific pain elimination was also similar between the two groups (TON R 58% vs. TON NR 64%; p=0.54).
CONCLUSIONS: Removal of the TON did not affect surgical success.
