From the Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School.
Boston, Mass.
Plast Reconstr Surg. 2021 Jan 1;147(1):176-180. doi: 10.1097/PRS.0000000000007484.
In an ongoing effort to understand the pathogenesis of occipital neuralgia/headache/migraine, it is critical to describe the anatomical/tissue changes encountered during surgery. Greater occipital nerve anatomical studies mainly focus on the greater occipital nerve course through muscle/fascial planes and interaction with the occipital vessels. However, structural soft-tissue changes have not been described in detail. Anecdotally, trapezius fascia is thickened at the greater occipital nerve trigger site. This study further investigates this observation. Patients undergoing greater occipital nerve decompression surgery were enrolled prospectively in this observational study (n = 92). Tissue changes were recorded intraoperatively. The resulting data were examined. Trapezius fascia was more than 3 mm thick and appeared fibrotic in 86 patients (94 percent), whereas semispinalis muscle appeared normal in all subjects. The greater occipital nerve was macroscopically abnormal, defined as edematous, flattened, and discolored in 29 cases (32 percent). The occipital artery interacted significantly with the greater occipital nerve in 88 percent of cases. The authors conclude that the tissue structure is abnormal in patients undergoing greater occipital nerve decompression surgery. This is the first study that describes the prevalence of thickened and fibrotic appearing trapezius fascia at the occipital trigger site, a phenomenon encountered in the vast majority of patients (94 percent). This structural anomaly has a resemblance to thickened fascial tissues seen in other nerve compression syndromes, and could be related to microtrauma/overuse or actual trauma in the head and neck region.
为了深入了解枕神经痛/头痛/偏头痛的发病机制，描述手术过程中遇到的解剖/组织变化至关重要。枕大神经解剖学研究主要集中在枕大神经穿过肌肉/筋膜平面的过程以及与枕血管的相互作用。然而，尚未详细描述结构软组织变化。据报道，斜方肌筋膜在枕大神经触发点增厚。本研究进一步对此进行了研究。前瞻性纳入接受枕大神经减压手术的患者进行本观察性研究（n=92）。术中记录组织变化。检查所得数据。86 例患者（94%）的斜方肌筋膜厚度超过 3 毫米，呈纤维状，而所有患者的半棘肌均正常。29 例（32%）的枕大神经肉眼异常，表现为水肿、扁平、变色。88%的病例中枕动脉与枕大神经显著相互作用。作者得出结论，接受枕大神经减压手术的患者的组织结构异常。这是第一项描述枕大神经触发点处增厚和纤维化的斜方肌筋膜出现的患病率的研究，这种现象在绝大多数患者（94%）中均可见。这种结构异常类似于在其他神经压迫综合征中看到的增厚的筋膜组织，可能与头颈部的微创伤/过度使用或实际创伤有关。
