From the Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center; Division of Plastic and Reconstructive Surgery and Department of Ophthalmology, McGill University Health Centre; and Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School.
Plast Reconstr Surg. 2022 Nov 1;150(5):1091-1097. doi: 10.1097/PRS.0000000000009623. Epub 2022 Sep 2.
Greater occipital nerve surgery has been shown to improve headaches caused by nerve compression. There is a paucity of data, however, specifically regarding the efficacy of concomitant occipital artery resection. To that end, the goal of this study was to compare the efficacy of greater occipital nerve decompression with and without occipital artery resection.
This multicenter retrospective cohort study consisted of two groups: an occipital artery resection group (artery identified and resected) and a control group (no occipital artery resection). Preoperative, 3-month, and 12-month migraine frequency, duration, intensity, Migraine Headache Index score, and complications were extracted and analyzed.
A total of 94 patients underwent greater occipital nerve decompression and met all inclusion criteria, with 78 in the occipital artery resection group and 16 in the control group. The groups did not differ in any of the demographic factors or preoperative migraine frequency, duration, intensity, or Migraine Headache Index score. Postoperatively, both groups demonstrated a significant decrease in migraine frequency, duration, intensity, and Migraine Headache Index score. The decrease in Migraine Headache Index score was significantly greater among the occipital artery resection group than the control group ( p = 0.019). Patients in both groups had no major complications and a very low rate of minor complications.
Occipital artery resection during greater occipital nerve decompression is safe and improves outcomes; therefore, it should be performed routinely.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
已证实，手术治疗枕大神经可改善因神经受压导致的头痛。然而，关于同时行枕动脉切除术的疗效数据却很少。因此，本研究的目的是比较单纯行枕大神经减压术与同时行枕动脉切除术的疗效。
这是一项多中心回顾性队列研究，分为两组：枕动脉切除术组（识别并切除枕动脉）和对照组（未行枕动脉切除术）。提取并分析了术前、术后 3 个月和 12 个月偏头痛发作频率、持续时间、强度、偏头痛头痛指数评分和并发症。
共 94 例患者行枕大神经减压术，均符合所有纳入标准，其中 78 例患者在枕动脉切除术组，16 例患者在对照组。两组在人口统计学因素或术前偏头痛发作频率、持续时间、强度或偏头痛头痛指数评分方面均无差异。术后两组偏头痛发作频率、持续时间、强度和偏头痛头痛指数评分均显著降低。枕动脉切除术组偏头痛头痛指数评分的降低明显大于对照组（p=0.019）。两组患者均无重大并发症，仅有极少数患者出现轻微并发症。
在枕大神经减压术中行枕动脉切除术是安全的，且可以改善疗效，因此应常规进行。
临床问题/证据水平：治疗性，III 级。
