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Excision of greater occipital nerves and 3rd occipital nerves

Abstract

Introduction: Occipital headache is a common, costly and debilitating disease process.When traditional therapies such as medication management and physical therapy fail to provide relief, surgical interventions may be considered. This procedure involves the excision of the 3rd and  both greater occipital nerves. 

Case presentation: 36 years old. female with history of chronic refractory occipital headaches  involving both greater occipital nerves and 3rd occipital nerves who presented for resection of those nerves.

Methods: A 10cm incision was marked on the posterior neck, positioned inferior to the occipital  skull base. Subsequently, the incision was carefully extended through the subcutaneous tissue. By means of both blunt and sharp dissection through the posterior muscle fascia where it inserts into the skull base, the right greater occipital nerve was identified and dissected into the paravertebral muscles and several centimeter of the nerve was resected so it could not grow back together. A corresponding procedure was employed for the left greater occipital nerve, located approximately 3 cm from the midline, and excised using the same technique. Additionally, the third occipital nerves situated in the midline were excised to address the entirety of the issue. Following these procedures, the wound was thoroughly irrigated with normal saline to ensure cleanliness, and hemostasis was diligently maintained throughout the surgical intervention using both monopolar and bipolar cautery. To alleviate postoperative discomfort, 0.5% Marcaine with epinephrine was carefully injected into the nerve areas.

The fascia needs to be closed with  strong sutures and  the skin and subcutaneous tissue were closed  in two layers. 

Conclusion :The excision of  greater occipital nerves presents a viable option for the management of chronic occipital headaches when conservative treatments prove ineffective. This case report highlights the successful outcome of such a procedure in a 36-year-old female suffering from debilitating headaches

Surgeons:

Dang-Khoa Nguyen, MD

James Y Suen,MD

Conflicts of Interest: None

Funding: This research received no external funding

Department of Otolaryngology – Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA

A 10cm incision was marked on the posterior neck, positioned inferior to the occipital skull base. Subsequently, the incision was carefully extended through the subcutaneous tissue. By means of both blunt and sharp dissection through the posterior muscle fascia where it inserts into the skull base, the right greater occipital nerve was identified and dissected into the paravertebral muscles and several centimeter of the nerve was resected so it could not grow back together. A corresponding procedure was employed for the left greater occipital nerve, located approximately 3 cm from the midline, and excised using the same technique. Additionally, the third occipital nerves situated in the midline were excised to address the entirety of the issue. Following these procedures, the wound was thoroughly irrigated with normal saline to ensure cleanliness, and hemostasis was diligently maintained throughout the surgical intervention using both monopolar and bipolar cautery. To alleviate postoperative discomfort, 0.5% Marcaine with epinephrine was carefully injected into the nerve areas. The fascia needs to be closed with strong sutures and the skin and subcutaneous tissue were closed in two layers.
36 years old. female with history of chronic refractory occipital headaches who presented for resection of greater occipital nerves.
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advantages, migraine headache relief Disadvantages, loss of sensation to the skin of the back of the scalp up to the vertex of the skull, the ear, and the skin just above the parotid gland
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1.Lipton R.B., Bigal M.E., Diamond M., et. al.: Migraine prevalence, disease burden, and the need for preventive therapy. Neurology 2007; 68: pp. 343-349. 2.Kung T.A., Guyuron B., Cederna P.S.: Migraine surgery: a plastic surgery solution for refractory migraine headache. Plast Reconstr Surg 2010; 127: pp. 181-189.

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