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Surgical Treatment of the Lesser Occipital Nerve

  • Ziv M. Peled
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Abstract

The lesser occipital nerve (LON) is a spinal, purely sensory nerve that originates from the second and third cervical vertebrae. It is a branch of the cervical plexus and arises from the lateral branch of the ventral ramus of the second and third cervical nerves. Upon emerging from the spinal cord, the nerve pierces Erb’s point consistently cephalic to the great auricular nerve where it passes in relatively close proximity to the spinal accessory nerve. The lesser occipital nerve then typically travels between the fascia of the splenius muscle and the sternocleidomastoid muscle and ascends along the posterior border of the latter until it penetrates the deep fascia at the nuchal line to become more superficial. Cephalic to this point, the nerve travels within the subcutaneous tissues where it innervates an area of the scalp located behind the auricle and the lateral occipital region.

Keywords

Lesser occipital nerve Occipital neuralgia Chronic headaches Migraine surgery Headache surgery 

References

  1. 1.
    Dougherty C. Occipital neuralgia. Curr Pain Headache Rep. 2014;18(5):411.PubMedCrossRefGoogle Scholar
  2. 2.
    Moore KL, Dalley AF, Agur AMR. In: Moore KL, Dalley AF, editors. Clinically oriented anatomy. 5th ed. Philadelphia: Lippincott Williams & Wilkins; 2006. 1209.Google Scholar
  3. 3.
    Araujo Lucas G, Laudanna A, Chopard RP, Raffaelli E. Anatomy of the lesser occipital nerve in relation to cervicogenic headache. Clin Anat. 1994;7:90–6.CrossRefGoogle Scholar
  4. 4.
    Dash KS, Janis JE, Guyuron B. The lesser and third occipital nerves and migraine headaches. Plast Reconstr Surg. 2005;115(6):1752–8; discussion 1759-60PubMedCrossRefGoogle Scholar
  5. 5.
    Pantaloni M, Sullivan P. Relevance of the lesser occipital nerve in facial rejuvenation surgery. Plast Reconstr Surg. 2000;105(7):2594–9; discussion 2600–3.PubMedCrossRefGoogle Scholar
  6. 6.
    Becser N, Bovim G, Sjaastad O. Extracranial nerves in the posterior part of the head. Anatomic variations and their possible clinical significance. Spine (Phila Pa 1976). 1998;23(13):1435–41.CrossRefGoogle Scholar
  7. 7.
    Lee M, et al. An anatomical study of the lesser occipital nerve and its potential compression points: implications for surgical treatment of migraine headaches. Plast Reconstr Surg. 2013;132(6):1551–6.PubMedGoogle Scholar
  8. 8.
    Peled ZM, Pietramaggiori G, Scherer S. Anatomic and compression topography of the lesser occipital nerve. Plast Reconstr Surg Glob Open. 2016;4(3):e639.PubMedPubMedCentralCrossRefGoogle Scholar
  9. 9.
    Ravindra SS, et al. An anatomical variation of the lesser occipital nerve in the “Carefree part” of the posterior triangle. J Clin Diagn Res. 2014;8(4):AD05–6.Google Scholar
  10. 10.
    Bogduk N. The anatomy and pathophysiology of whiplash. Clin Biomech (Bristol, Avon). 1986;1(2):92–101.CrossRefGoogle Scholar
  11. 11.
    Davis CG. Mechanisms of chronic pain from whiplash injury. J Forensic Legal Med. 2013;20(2):74–85.CrossRefGoogle Scholar
  12. 12.
    Janis JE, Dhanik A, Howard JH. Validation of the peripheral trigger point theory of migraine headaches: single-surgeon experience using botulinum toxin and surgical decompression. Plast Reconstr Surg. 2011;128(1):123–31.PubMedCrossRefGoogle Scholar
  13. 13.
    Narouze S. Occipital neuralgia diagnosis and treatment: the role of ultrasound. Headache. 2016;56(4):801–7.PubMedCrossRefGoogle Scholar
  14. 14.
    Watanabe K, et al. An anatomical study of the transversus nuchae muscle: application to better understanding occipital neuralgia. Clin Anat. 2017;30(1):32–8.PubMedCrossRefGoogle Scholar
  15. 15.
    Cesmebasi A, et al. Occipital neuralgia: anatomic considerations. Clin Anat. 2015;28(1):101–8.PubMedCrossRefGoogle Scholar
  16. 16.
    Trescot AM. Peripheral Nerve Entrapments. 1st ed. Switzerland: Springer International Publishing; 2016. 901.CrossRefGoogle Scholar
  17. 17.
    Madhavi C, Holla SJ. Triplication of the lesser occipital nerve. Clin Anat. 2004;17(8):667–71.PubMedCrossRefGoogle Scholar
  18. 18.
    Bogduk N, Marsland A. On the concept of third occipital headache. J Neurol Neurosurg Psychiatry. 1986;49(7):775–80.PubMedPubMedCentralCrossRefGoogle Scholar
  19. 19.
    Ducic I, Moriarty M, Al-Attar A. Anatomical variations of the occipital nerves: implications for the treatment of chronic headaches. Plast Reconstr Surg. 2009;123(3):859–63; discussion 864PubMedCrossRefGoogle Scholar
  20. 20.
    Gfrerer L, Guyuron B. Surgical treatment of migraine headaches. Acta Neurol Belg. 2017;117(1):27–32.PubMedCrossRefGoogle Scholar
  21. 21.
    Gfrerer L, et al. Nonendoscopic deactivation of nerve triggers in migraine headache patients: surgical technique and outcomes. Plast Reconstr Surg. 2014;134(4):771–8.PubMedCrossRefGoogle Scholar
  22. 22.
    Mosser SW, et al. The anatomy of the greater occipital nerve: implications for the etiology of migraine headaches. Plast Reconstr Surg. 2004;113(2):693–7; discussion 698–700.PubMedCrossRefGoogle Scholar
  23. 23.
    Guyuron B, et al. Comprehensive surgical treatment of migraine headaches. Plast Reconstr Surg. 2005;115(1):1–9.PubMedCrossRefGoogle Scholar
  24. 24.
    Jung SJ, et al. A case of occipital neuralgia in the greater and lesser occipital nerves treated with neurectomy by using transcranial Doppler sonography: technical aspects. Korean J Pain. 2011;24(1):48–52.PubMedPubMedCentralCrossRefGoogle Scholar
  25. 25.
    Platzgummer H, et al. The lesser occipital nerve visualized by high-resolution sonography – normal and initial suspect findings. Cephalalgia. 2015;35(9):816–24.PubMedCrossRefGoogle Scholar
  26. 26.
    Guyuron B, Tucker T, Davis J. Surgical treatment of migraine headaches. Plast Reconstr Surg. 2002;109(7):2183–9.PubMedCrossRefGoogle Scholar
  27. 27.
    Kinney MA, et al. Prolonged facial hypesthesia resulting from greater occipital nerve block. Clin Anat. 2003;16(4):362–5.PubMedCrossRefGoogle Scholar
  28. 28.
    Strauss L, Loder E, Rizzoli P. Transient facial nerve palsy after occipital nerve block: a case report. Headache. 2014;54(10):1651–5.PubMedCrossRefGoogle Scholar
  29. 29.
    Khavanin N, et al. Surgical “safe zone”: rapid anatomical identification of the lesser occipital nerve. J Reconstr Microsurg. 2019;35(5):341–5.PubMedCrossRefGoogle Scholar
  30. 30.
    Ducic I, Hartmann EC, Larson EE. Indications and outcomes for surgical treatment of patients with chronic migraine headaches caused by occipital neuralgia. Plast Reconstr Surg. 2009;123(5):1453–61.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Ziv M. Peled
    • 1
  1. 1.Peled Plastic SurgerySan FranciscoUSA

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