Department of Plastic Surgery, Case Western Reserve University, Cleveland, OH 44106, USA.
J Plast Reconstr Aesthet Surg. 2013 Oct;66(10):1335-9. doi: 10.1016/j.bjps.2013.05.023. Epub 2013 Jun 2.
The third occipital nerve is often encountered during the occipital migraine surgery, however its contribution to migraine headaches is unclear. The objective of this study was to determine whether removing the third occipital nerve plays any role in the clinical outcomes of occipital migraine surgery.
A retrospective comparative review was conducted on all occipital migraine headache (Site IV) patients from 1/2000 to 12/2010. Inclusion criteria were: 1) completion of migraine questionnaire, 2) migraine Site IV decompression, and 3) minimum 6 months of follow-up. Patients were divided into those who had the third occipital nerve removed and those who did not. Outcome variables included overall Migraine Headache Index reduction and Site IV pain elimination.
229 patients met the study inclusion criteria. The third occipital nerve removed group (111 patients) and the third occipital nerve not removed group (118 patients) were comparable in terms of age, gender, number of surgical sites, and statistically well matched regarding preoperative headache characteristics. Comparing the third occipital nerve removed to the third occipital nerve not removed group, Migraine headache index reduction was 63% vs. 64%. Patients experiencing migraine headache elimination (third occipital nerve removed 26% vs. third occipital nerve not removed 29%; p=0.45) and surgery success with at least 50% reduction in migraine headache (third occipital nerve removed 80% vs. third occipital nerve not removed 81%; p=0.82) were also similar. There was also no difference between the two groups in symptomatic neuroma formation. Site IV specific pain elimination was similar between the two groups (third occipital nerve removed 58% vs. third occipital nerve not removed 64%; p=0.54).
Removal of the third occipital nerve did not alter migraine surgery success.
在枕大神经偏头痛手术中，第三枕大神经经常会被碰到，但它对偏头痛头痛的影响尚不清楚。本研究的目的是确定切除第三枕大神经在枕大神经偏头痛手术的临床结果中是否起作用。
对 2000 年 1 月至 2010 年 12 月所有枕大神经偏头痛（Site IV）患者进行回顾性比较分析。纳入标准为：1）完成偏头痛问卷，2）偏头痛 Site IV 减压，3）随访至少 6 个月。患者分为切除第三枕大神经组和未切除第三枕大神经组。观察指标包括偏头痛头痛指数总体降低和 Site IV 疼痛消除。
229 例患者符合研究纳入标准。切除第三枕大神经组（111 例）和未切除第三枕大神经组（118 例）在年龄、性别、手术部位数量等方面无差异，术前头痛特征具有统计学可比性。与未切除第三枕大神经组相比，切除第三枕大神经组偏头痛头痛指数降低了 63%（64% vs. 63%）。偏头痛头痛消除率（切除第三枕大神经组 26%，未切除第三枕大神经组 29%；p=0.45）和手术成功率（偏头痛头痛减少至少 50%，切除第三枕大神经组 80%，未切除第三枕大神经组 81%；p=0.82）也相似。两组症状性神经瘤发生率无差异。两组 Site IV 特异性疼痛消除率相似（切除第三枕大神经组 58%，未切除第三枕大神经组 64%；p=0.54）。
切除第三枕大神经不会改变偏头痛手术的成功率。
