Department of Anatomy, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
J Anat. 2024 Feb;244(2):312-324. doi: 10.1111/joa.13959. Epub 2023 Sep 30.
Being one of the most prevalent neurological symptoms, headaches are burdensome and costly. Blocks and decompression surgeries of the greater occipital nerve (GON) have been frequently used for migraine, cervicogenic headache, and occipital neuralgia which are classified under headache by International Headache Society. Knowledge of complex anatomy of GON is crucial for its decompression surgery and block. This study was performed to elucidate anatomical features of this nerve in detail. Forty-one cadavers were dissected bilaterally. According to its morphological features, GON was classified into four main types that included 18 subtypes. Moreover, potential compression points of the nerve were defined. The number of branches of the GON up to semispinalis capitis muscle and the number of its branches that were sent to this muscle were recorded. The most common variant was that the GON pierced the aponeurosis of the trapezius muscle, curved around the lower edge of the obliquus capitis inferior muscle, and was loosely attached to the obliquus capitis inferior muscle (Type 2; 61 sides, 74.4%). In the subtypes, the most common form was Type 2-A (44 sides, 53.6%), in which the GON pierced the aponeurosis of each of the trapezius muscle and fibers of semispinalis muscle at one point and there was a single crossing of the GON and occipital artery. Six potential compression points of the GON were detected. The first point was where the nerve crossed the lower border of the obliquus capitis inferior muscle. The second and third points were at its piercing of the semispinalis capitis muscle and the muscle fibers/aponeurosis of the trapezius, respectively. Fourth, fifth, and sixth compression points of GON were located where the GON and occipital artery crossed each other for the first, second, and third times, respectively. On 69 sides, 1-4 branches of the GON up to the semispinalis capitis muscle were observed (median = 1), while 1-4 branches of GON were sent to the semispinalis capitis muscle on 67 sides (median = 1). The novel anatomical findings described in this study may play a significant role in increasing the success rate of invasive interventions related with the GON.
头痛是最常见的神经症状之一，给患者带来了沉重的负担和高昂的医疗费用。枕大神经阻滞和减压术已被广泛应用于偏头痛、颈源性头痛和枕神经痛的治疗，这些疾病都被国际头痛协会归类为头痛。因此，了解枕大神经的复杂解剖结构对于其减压和阻滞手术至关重要。本研究旨在详细阐明该神经的解剖学特征。41 具尸体双侧解剖。根据其形态学特征，枕大神经分为 4 个主要类型，包括 18 个亚型。此外，还定义了神经的潜在受压点。记录了枕大神经至头半棘肌的分支数和分布到头半棘肌的分支数。最常见的变异是枕大神经穿过斜方肌腱膜，绕过头下斜肌的下缘，然后松散地附着在头下斜肌上（2 型；61 侧，74.4%）。在亚型中，最常见的形式是 2-A 型（44 侧，53.6%），其中枕大神经在一点处穿过斜方肌肌腱和半棘肌纤维，并且枕大神经和枕动脉有一次交叉。检测到枕大神经的 6 个潜在受压点。第一个受压点是神经穿过头下斜肌下缘的地方。第二和第三个受压点分别在枕大神经穿过头半棘肌和穿过斜方肌肌腱/肌膜处。第四、第五和第六个受压点分别位于枕大神经和枕动脉第一次、第二次和第三次交叉处。在 69 侧中，观察到枕大神经至头半棘肌的 1-4 个分支（中位数=1），而在 67 侧中，枕大神经有 1-4 个分支分布到头半棘肌（中位数=1）。本研究描述的新解剖学发现可能在提高与枕大神经相关的侵袭性干预的成功率方面发挥重要作用。
