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

作者：Lee Michelle; Brown Matthew; Chepla Kyle; Okada Haruko; Gatherwright James; Totonchi Ali; Alleyne Brendan; Zwiebel Samantha; Kurlander David; Guyuron Bahman^*

来源：Plastic and Reconstructive Surgery, 2013, 132(6): 1551-1556.

DOI：10.1097/PRS.0b013e3182a80721

Background: This study maps the course of the lesser occipital nerve and its potential compression sites in the posterior scalp. %26lt;br%26gt;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. %26lt;br%26gt;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). %26lt;br%26gt;Conclusion: This anatomical study traced the lesser occipital nerve as it courses through the posterior scalp and mapped its potential decompression sites.