Peled Ziv M, Pietramaggiori Giorgio, Scherer Saja
Peled Plastic Surgery, San Francisco, CA; and Plastic Surgery Department, University Hospital of Lausanne (CHUV), Lausanne, Switzerland.
Plast Reconstr Surg Glob Open. 2016 Mar 17;4(3):e639. doi: 10.1097/GOX.0000000000000654. eCollection 2016 Mar.
The surgical treatment of occipital headaches focuses on the greater, lesser, and third occipital nerves. The lesser occipital nerve (LON) is usually transected with relatively limited available information regarding the compression topography thereof and how such knowledge may impact surgical treatment.
Eight fresh frozen cadavers were dissected focusing on the LON in relation to 3 clinically relevant compression zones. The x axis was a line drawn through the occipital protuberance (OP) and the y axis, the posterior midline (PM). In addition, a prospectively collected cohort of 36 patients who underwent decompression of the LON is presented with their clinical results, including migraine headache index scores.
The LON was found in compression zone 1, with a mean of 7.8 cm caudal to the OP and 6.3 cm lateral to the PM. The LON was found at the midpoint of compression zone 2, with an average of 5.5 cm caudal to the OP and 6.2 cm lateral to the PM. At compression zone 3, the medial-most LON branch was located approximately 1 cm caudal to the OP and 5.35 cm lateral to the PM, whereas the lateral-most branch was identified 1 cm caudal to the OP and 6.5 cm lateral to the PM. Of the 36 decompression patients analyzed, only 5 (14%) required neurectomy as the remainder achieved statistically significant improvements in migraine headache index scores postoperatively.
The knowledge of LON anatomy can aid in nerve dissection and preservation, thereby leading to successful outcomes without requiring neurectomy.
枕部头痛的手术治疗主要针对枕大神经、枕小神经和第三枕神经。枕小神经（LON）通常在关于其压迫部位及此类知识如何影响手术治疗的可用信息相对有限的情况下被切断。
对8具新鲜冷冻尸体进行解剖，重点研究与3个临床相关压迫区域相关的枕小神经。x轴是一条穿过枕外隆凸（OP）的线，y轴是后正中线（PM）。此外，还展示了一个前瞻性收集的36例行枕小神经减压术患者的队列及其临床结果，包括偏头痛指数评分。
在压迫区域1发现枕小神经，平均位于枕外隆凸尾侧7.8 cm和后正中线外侧6.3 cm处。在压迫区域2的中点发现枕小神经，平均位于枕外隆凸尾侧5.5 cm和后正中线外侧6.2 cm处。在压迫区域3，最内侧的枕小神经分支位于枕外隆凸尾侧约1 cm和后正中线外侧5.35 cm处，而最外侧的分支位于枕外隆凸尾侧1 cm和后正中线外侧6.5 cm处。在分析的36例减压患者中，只有5例（14%）需要进行神经切除术，其余患者术后偏头痛指数评分有统计学意义的改善。
了解枕小神经的解剖结构有助于神经解剖和保留，从而在无需进行神经切除术的情况下取得成功的治疗效果。
