From the University of Texas Southwestern Medical Center.
Plast Reconstr Surg. 2023 Sep 1;152(3):641-643. doi: 10.1097/PRS.0000000000010290. Epub 2023 Feb 14.
In the occipital trigger site for migraine, the greater occipital nerve (GON) is thought to be irritated by surrounding structures, including the semispinalis capitis muscle and occipital artery (OA), producing headaches in the back of the neck. Thus, standard decompression involves removal of surrounding tissue and dissection away from the vessel. The authors noticed a consistent pattern between the GON and OA more distally: the OA approaching laterally and diving under the GON, the OA looping back over the GON and intertwining with the medial branch of the GON, and lastly the OA traveling parallel to the GON. The technique described uses a modified endoscopic approach with a counter incision, endoscopic assistance, and radical artery lysis to address distal sites in addition to the standard release. At the counter incision, distal intertwining between vessel and nerve was released. A high-definition endoscope was used to address dynamic compression points more proximally, including hidden areas where the vessel dives under the GON, as well as to facilitate cautery and removal of the vessel. Without the use of an endoscope and counterincision, it is difficult to achieve complete decompression of the nerve distally without injury to the proximal body of the nerve.
在偏头痛的枕部触发点，人们认为枕大神经（GON）被周围结构（包括头半棘肌和枕动脉（OA））刺激，从而引起颈后部头痛。因此，标准减压术包括去除周围组织和与血管分离。作者注意到 GON 和 OA 之间在更远端存在一种一致的模式：OA 向外侧靠近并在 GON 下方潜入，OA 向后绕过 GON 并与 GON 的内侧分支交织，最后 OA 与 GON 平行。所描述的技术使用改良的内镜入路和对切切口、内镜辅助以及彻底的动脉松解术来解决标准释放之外的远端部位。在对切切口中，释放了血管和神经之间的远端交织。使用高清内镜解决更近端的动态压迫点，包括血管潜入 GON 下方的隐藏区域，以及方便电烙和切除血管。如果不使用内镜和对切切口，很难在不损伤近端神经体的情况下实现神经的完全减压。
