The Greater Occipital Nerve and Obliquus Capitis Inferior Muscle: Anatomical Interactions and Implications for Occipital Pain Syndromes

Scherer, Saja; Schiraldi, Luigi; Sapino, Gianluca; Cambiaso‐Daniel, Janos; Gualdi, Alessandro; Peled, Ziv M.; Hagan, Robert R.; Pietramaggiori, Giorgio

doi:10.1097/prs.0000000000005945

Cited by 7 publications

(8 citation statements)

References 14 publications

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“…Several anatomical studies have been published on the occipital nerves, describing the critical compression points along their trajectory. [6][7][8][9][10][11][12][13][14] Kwon et al, 15 using Sihler staining, show the anatomical complexity and imbrication between the greater, lesser, and third occipital nerves and the occipital artery. This study shows that main sensitive nerve branches converge in a region described by Janis et al as points 5 and 6, 6 which is where the greater occipital nerve pierces the nuchal line and intersects the occipital artery.…”

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confidence: 99%

Minimally Invasive Nerve- and Muscle-Sparing Surgical Decompression for Occipital Neuralgia

Pietramaggiori

Scherer

2022

Plastic &Amp; Reconstructive Surgery

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Background: Occipital neuralgia is a well-defined type of headache, and its treatment algorithm is still debated across medical specialties. From the analysis of the literature, it appears that surgical decompression of the occipital nerves is the most effective invasive approach to improve the quality of life of patients with occipital neuralgia refractory to medications. The authors describe here a minimally invasive nerve- and muscle-sparing technique to decompress the occipital nerves. Methods: The results in terms of reduction of migraine days per month, use of medications, pain evaluation, and decrease in Migraine Headache Index were analyzed by means of a retrospective chart review of 87 patients who underwent nerve- and muscle-sparing surgical decompression of the greater and lesser monolateral or bilateral occipital nerves in their institution and were followed up for at least 12 months. The surgical technique is described in detail. Results: Surgical decompression significantly reduced occipital neuralgia burden (at least 50% improvement) in 91% of patients, with 45% reporting a complete remission of occipital pain. Days with pain per month decreased by 80%, chronic background pain intensity decreased by 81%, and pain intensity during crisis decreased by 76%. Accordingly, drug use dropped by approximately 70%. Only minor complications were reported in four patients. Conclusions: The described technique could contribute to and further support surgical decompression as the first option among the invasive approaches to treat occipital neuralgia. Results corroborate previous findings, adding a less-invasive, nerve- and muscle-sparing approach. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

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confidence: 99%

Minimally Invasive Nerve- and Muscle-Sparing Surgical Decompression for Occipital Neuralgia

Pietramaggiori

Scherer

2022

Plastic &Amp; Reconstructive Surgery

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“…Huanmanop et al ( 2021 ) stated that GON rose by curving from the lower border of OCI on 94 (94%) sides, and pierced OCI near the lower edge of this muscle on six (6%) sides. Scherer et al ( 2019 ) determined that GON ascended by curving from the lower border of OCI on 38 (95%) sides and pierced OCI on two (5%) sides. In addition, unlike previous studies, GONs ascending by turning from the lower edge of OCI were subdivided into two separate subgroups by Scherer et al ( 2019 ); they reported that GON was loosely connected to OCI on seven (17.5%) sides and firmly attached either to the muscle itself or to its fascia on 31 (77.5%) sides.…”

Section: Discussionmentioning

confidence: 99%

Morphological features of the greater occipital nerve and its possible importance for interventional procedures

Saglam,

Gayretli,

Coskun

et al. 2023

Journal of Anatomy

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Being one of the most prevalent neurological symptoms, headaches are burdensome and costly. Blocks and decompression surgeries of the greater occipital nerve (GON) have been frequently used for migraine, cervicogenic headache, and occipital neuralgia which are classified under headache by International Headache Society. Knowledge of complex anatomy of GON is crucial for its decompression surgery and block. This study was performed to elucidate anatomical features of this nerve in detail. Forty‐one cadavers were dissected bilaterally. According to its morphological features, GON was classified into four main types that included 18 subtypes. Moreover, potential compression points of the nerve were defined. The number of branches of the GON up to semispinalis capitis muscle and the number of its branches that were sent to this muscle were recorded. The most common variant was that the GON pierced the aponeurosis of the trapezius muscle, curved around the lower edge of the obliquus capitis inferior muscle, and was loosely attached to the obliquus capitis inferior muscle (Type 2; 61 sides, 74.4%). In the subtypes, the most common form was Type 2‐A (44 sides, 53.6%), in which the GON pierced the aponeurosis of each of the trapezius muscle and fibers of semispinalis muscle at one point and there was a single crossing of the GON and occipital artery. Six potential compression points of the GON were detected. The first point was where the nerve crossed the lower border of the obliquus capitis inferior muscle. The second and third points were at its piercing of the semispinalis capitis muscle and the muscle fibers/aponeurosis of the trapezius, respectively. Fourth, fifth, and sixth compression points of GON were located where the GON and occipital artery crossed each other for the first, second, and third times, respectively. On 69 sides, 1–4 branches of the GON up to the semispinalis capitis muscle were observed (median = 1), while 1–4 branches of GON were sent to the semispinalis capitis muscle on 67 sides (median = 1). The novel anatomical findings described in this study may play a significant role in increasing the success rate of invasive interventions related with the GON.

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“…17 This intersection was identified as the anatomical reference point for minimally invasive posterior atlantoaxial fusion. Scherer et al 19 measured the mean distance from the C2 spinous process to the C1 transverse process, namely the mean length of the inferior cephalic oblique muscle, to be 5.60 AE 0.46 cm, and the mean distance between the C2 spinous process and the intersection of the greater occipital nerve on the inferior cephalic oblique muscle to be 3.56 AE 0.36 cm from 20 cadaveric specimens. The mean distance from the C2 spinous process to the C1 transverse process measured in this study was 47.66 AE 4.76 mm, and the distance from the C2 spinous process to the intersection of the greater occipital nerve and the inferior cephalic oblique muscle was 25.09 AE 3.53 mm.…”

Section: Anatomical Reference Pointmentioning

confidence: 99%

“…The occipital greater nerve emerges from the dorsal branch of the C2 nerve, passes medially from the inferior edge of the inferior cephalic oblique muscle, traverses obliquely through the suboccipital triangle, and then extends laterally along the posterior cephalic greater rectus muscle. The diameter of the occipital greater nerve can reach up to 3.5 mm, and it has a close relationship with the inferior cephalic oblique muscle 17–19 . Consequently, the intersection of the occipital greater nerve and the inferior edge of the inferior cephalic oblique muscle is a significant point of interest in these procedures.…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of the Anatomical Reference Point in Posterior Minimally Invasive Atlantoaxial Spine Surgery: A Cadaveric Anatomical Study

Lian,

Chen,

Wang

et al. 2024

Orthopaedic Surgery

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ObjectiveMinimally invasive atlantoaxial surgery offers the benefits of reduced trauma and quicker recovery. Previous studies have focused on feasibility and technical aspects, but the lack of comprehensive safety information has limited its availability and widespread use. This study proposes to define the feasibility and range of surgical safety using the intersection of the greater occipital nerve and the inferior border of the inferior cephalic oblique as a reference point.MethodsDissection was performed on 10 fresh cadavers to define the anatomical reference point as the intersection of the greater occipital nerve and the inferior border of the inferior cephalic oblique muscle. The study aimed to analyze the safety range of minimally invasive atlantoaxial fusion surgery by measuring the distance between the anatomical reference point and the transverse foramen of the axis, the distance between the anatomical reference point and the superior border of the posterior arch of the atlas, and the distance between the anatomical reference point and the spinal canal. Measurements were compared using Student's t test.ResultsThe point where the occipital greater nerve intersects with the inferior border of the inferior cephalic oblique muscle was defined as the anatomical marker for minimally invasive posterior atlantoaxial surgery. The distance between this anatomical marker and the transverse foramen of the axis was measured to be 9.32 ± 2.04 mm. Additionally, the distance to the superior border of the posterior arch of the atlas was found to be 21.29 ± 1.93 mm, and the distance to the spinal canal was measured to be 11.53 ± 2.18 mm. These measurement results can aid surgeons in protecting the vertebral artery and dura mater during minimally invasive posterior atlantoaxial surgery.ConclusionsThe intersection of the greater occipital nerve with the inferior border of the inferior cephalic oblique muscle is a safe and reliable anatomical landmark in minimally invasive posterior atlantoaxial surgery.

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The Greater Occipital Nerve and Obliquus Capitis Inferior Muscle: Anatomical Interactions and Implications for Occipital Pain Syndromes

Cited by 7 publications

References 14 publications

Minimally Invasive Nerve- and Muscle-Sparing Surgical Decompression for Occipital Neuralgia

Minimally Invasive Nerve- and Muscle-Sparing Surgical Decompression for Occipital Neuralgia

Morphological features of the greater occipital nerve and its possible importance for interventional procedures

Evaluation of the Anatomical Reference Point in Posterior Minimally Invasive Atlantoaxial Spine Surgery: A Cadaveric Anatomical Study

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