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Plastic & Reconstructive Surgery:
doi: 10.1097/PRS.0b013e3182a80721
Reconstructive: Head and Neck: Original Articles

An Anatomical Study of the Lesser Occipital Nerve and Its Potential Compression Points: Implications for Surgical Treatment of Migraine Headaches

Lee, Michelle M.D.; Brown, Matthew M.D.; Chepla, Kyle M.D.; Okada, Haruko M.D.; Gatherwright, James M.D.; Totonchi, Ali M.D.; Alleyne, Brendan B.S.; Zwiebel, Samantha B.A.; Kurlander, David B.S.; Guyuron, Bahman M.D.

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Abstract

Background: This study maps the course of the lesser occipital nerve and its potential compression sites in the posterior scalp.

Methods: Twenty sides of 10 fresh cadaveric heads were dissected. Two fixed anatomical landmarks were used: the y axis was the vertical midline in the posterior scalp through the midline of the cervical spine. The x axis was a horizontal line drawn between the most anterosuperior points of the external auditory meatus. A topographic map 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 6.4 ± 1.4 cm lateral to the y axis and 7.5 ± 0.9 cm caudal to the x axis. Branches of the occipital artery were found to interact with the lesser occipital nerve in 11 of the 20 hemiheads (55 percent). The mean location of the artery-nerve interaction was 5.1 ± 0.9 cm lateral to the y axis and 2 ± 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 in nine of 20 hemiheads (45 percent) and a helical intertwining relationship in two of 20 of hemiheads (10 percent). A fascial band was identified to compress the lesser occipital nerve in four of 20 hemiheads (20 percent).

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

©2013American Society of Plastic Surgeons

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