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Compression Points of Lesser Occipital Nerve:Implications for Surgical Treatment of Migraine Headaches

Michelle Lee MD, Matthew Brown MD, Kyle Chepla MD, Haruko Okada MD, James Gatherwright MD, Ali Totonchi MD, Brendan Alleyne BS, Samantha Zwiebel BA, Bahman Guyuron MD
Case Western Reserve University
2013-02-19

Presenter: TBD

Affidavit:
100% of the work is orginal to the group of residents

Director Name: Hooman Soltanian

Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction

Background: Lesser occipital nerve irritation is one of the peripheral triggers of occipital
headaches. The purpose of this anatomical study was to provide a topographic map of its course and potential compression sites.

Methods: Twenty sides of 10 fresh cadaveric heads were dissected to trace the course of the
lesser occipital nerve. Two fixed anatomical landmarks were used for obtaining standardized
measurements. A topographic map of the course of the lesser occipital nerve and its potential compression points was created.

Results: The lesser occipital nerve emerged from the posterior border of the sternocleidomastoid
muscle at an average of 6.4cm +/- 1.4 cm lateral to the y-axis and 7.5cm +/- 0.9cm caudal to the x-axis. Branches of the occipital artery were found to interact with the lesser occipital nerve in 55% (11 out of 20) of the hemiheads. The mean location of the artery-nerve interaction was 5.1cm +/- 0.9cm lateral to the y-axis and 2cm +/- 1.45 cm caudal to the x-axis. Two patterns of artery-nerve interaction were seen: a single site of artery crossing over the nerve 45% (9 out of 20) of hemiheads and a helical intertwining relationship 10% (2 out of 20) of hemiheads. A fascial band was identified to compress the lesser occipital nerve in 20% (4 out of 20) of hemiheads.

Conclusion: This anatomical study traced the lesser occipital nerve as it courses through the
posterior scalp and mapped its potential decompression sites.

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