<meta charset="utf8"></head><body>缓解枕神经痛：保留神经和肌肉的减压

<ol>
	<li>IHS. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+international+classification+of+headache+disorders,+3rd+edition.">The international classification of headache disorders, 3rd edition.</a> Cephalalgia. 38 (1), 1-211 (2018).</li><li>Mosser, S. W., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+anatomy+of+the+greater+occipital+nerve:+implications+for+the+etiology+of+migraine+headaches.">The anatomy of the greater occipital nerve: implications for the etiology of migraine headaches.</a> Plast Reconstr Surg. 113 (2), 693-697 (2004).</li><li>Janis, J. E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Neurovascular+compression+of+the+greater+occipital+nerve:+implications+for+migraine+headaches.">Neurovascular compression of the greater occipital nerve: implications for migraine headaches.</a> Plast Reconstr Surg. 126 (6), 1996-2001 (2010).</li><li>Guyuron, B., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Five-year+outcome+of+surgical+treatment+of+migraine+headaches.">Five-year outcome of surgical treatment of migraine headaches.</a> Plast Reconstr Surg. 127 (2), 603-608 (2011).</li><li>Blake, P., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Tracking+patients+with+chronic+occipital+headache+after+occipital+nerve+decompression+surgery:+A+case+series.">Tracking patients with chronic occipital headache after occipital nerve decompression surgery: A case series.</a> Cephalalgia. 39 (4), 556-563 (2019).</li><li>Pietramaggiori, G., Scherer, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Minimally+invasive+nerve-+and+muscle-sparing+surgical+decompression+for+occipital+neuralgia.">Minimally invasive nerve- and muscle-sparing surgical decompression for occipital neuralgia.</a> Plast Reconstr Surg. 151 (1), 169-177 (2023).</li><li>Tobin, J., Flitman, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Treatment+of+migraine+with+occipital+nerve+blocks+using+only+corticosteroids.">Treatment of migraine with occipital nerve blocks using only corticosteroids.</a> Headache. 51 (1), 155-159 (2011).</li><li>Seyed Forootan, N. S., Lee, M., Guyuron, B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Migraine+headache+trigger+site+prevalence+analysis+of+2590+sites+in+1010+patients.">Migraine headache trigger site prevalence analysis of 2590 sites in 1010 patients.</a> J Plast Reconstr Aesthet Surg. 70 (2), 152-158 (2017).</li><li>Pietramaggiori, G., Scherer, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Minimally invasive surgery for chronic pain management. , (2020).</li><li>Janis, J. E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+anatomy+of+the+greater+occipital+nerve:+Part+II.+Compression+point+topography.">The anatomy of the greater occipital nerve: Part II. Compression point topography.</a> Plast Reconstr Surg. 126 (5), 1563-1572 (2010).</li><li>Ducic, I., Moriarty, M., Al-Attar, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Anatomical+variations+of+the+occipital+nerves:+implications+for+the+treatment+of+chronic+headaches.">Anatomical variations of the occipital nerves: implications for the treatment of chronic headaches.</a> Plast Reconstr Surg. 123 (3), 859-863 (2009).</li><li>Junewicz, A., Katira, K., Guyuron, B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Intraoperative+anatomical+variations+during+greater+occipital+nerve+decompression.">Intraoperative anatomical variations during greater occipital nerve decompression.</a> J Plast Reconstr Aesthet Surg. 66 (10), 1340-1345 (2013).</li><li>Scherer, S. S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+greater+occipital+nerve+and+obliquus+capitis+inferior+muscle:+Anatomical+interactions+and+implications+for+occipital+pain+syndromes.">The greater occipital nerve and obliquus capitis inferior muscle: Anatomical interactions and implications for occipital pain syndromes.</a> Plast Reconstr Surg. 144 (3), 730-736 (2019).</li><li>Koopman, J. S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Incidence+of+facial+pain+in+the+general+population.">Incidence of facial pain in the general population.</a> Pain. 147 (1-3), 122-127 (2009).</li><li>Mathew, P. G., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Prevalence+of+occipital+neuralgia+at+a+community+hospital-based+headache+clinic.">Prevalence of occipital neuralgia at a community hospital-based headache clinic.</a> Neurol Clin Pract. 11 (1), 6-12 (2021).</li></ol>

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>30G Needle</td>
			<td>0.3x13 mm, BD Microlance 3, Spain</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Bipolar Forceps</td>
			<td>McPerson, bipolar forceps, Erbe, Switzerland</td>
			<td>20195</td>
			<td></td>
		</tr>
		<tr>
			<td>Chlorhexidine</td>
			<td>Hibidil, Chlorhexidini digluconas 0.5 mg/mL, Switzerland</td>
			<td>120099</td>
			<td></td>
		</tr>
		<tr>
			<td>dissection scissors</td>
			<td>Jarit supercut, Integra Lifescience, USA</td>
			<td>323720</td>
			<td></td>
		</tr>
		<tr>
			<td>Doppler</td>
			<td>Dopplex DMX Digital Doppler, High Sensitivity 10MHz probe, Huntleigh Healthcare, Wales, United Kingdom</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Ethilon 5/0 Suture</td>
			<td>Ethicon, USA</td>
			<td>698 G</td>
			<td></td>
		</tr>
		<tr>
			<td>Lidocaine ephinephrine 1%</td>
			<td>Rapidocain 1% 10 mg/mL, Sintetica, Switzerland</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Lighted retractor</td>
			<td>Electro Surgical Instrument Company, Rochester, NY</td>
			<td>08-0195</td>
			<td></td>
		</tr>
		<tr>
			<td>Magnifying loops</td>
			<td>Design for vision, USA</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Opsity spray</td>
			<td>Smith &#38; Nephew, USA</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Sterile gloves</td>
			<td>Sempermed sintegra IR, Ireland</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Sterillium</td>
			<td>Sterillium disinfectant, Switzerland</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Surgical blade n.15</td>
			<td>Carbon steel surgical blades, Swann-Morton, England)</td>
			<td>205</td>
			<td></td>
		</tr>
		<tr>
			<td>Surgical drapes and gauzes</td>
			<td>Halyard Universal pack, USA</td>
			<td>88761</td>
			<td></td>
		</tr>
		<tr>
			<td>Surgical instruments</td>
			<td>Bontempi medical Italy</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Surgical shaver</td>
			<td>Carefusion, USA</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Syringe 5cc</td>
			<td>BBraun, Omnifix Luer Lock Solo, Switzerland</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Triamcinolone 10mg</td>
			<td>Triamcort depot 40 mg/mL, Zentiva Czech Republic</td>
			<td></td>
			<td></td>
		</tr>
	</tbody>
</table>

minimally invasive surgical decompression of occipital nerves

Occipital neuralgia (ON) is a chronic headache condition causing persistent dull pain in the back of the head1. The pain, which differs from typical migraines, is often resistant to standard migraine treatments due to mechanical compression on the occipital nerves2, particularly along their course through the nuchal line3. On the other hand, surgical options may be effective but involve invasive procedures and extended recovery times4,5. We present here a novel approach to the occipital nerves, allowing for minimally invasive decompression, minimal downtime, and preservation of muscle and sensitive nerve branches6.
Diagnosing ON relies on targeted nerve blocks, which temporarily reduce pain and help pinpoint the exact area of nerve compression7, guiding surgical decompression8,9. Unlike typical migraine management, our approach targets the root mechanical cause of ON, providing a viable therapeutic option beyond medication.
Numerous clinical and anatomical studies have led to the occipital nerve decompression technique as described in2,3,10,11,12,13. Although this technique has been proven safe and effective, the advantages of the minimally invasive technique presented here include reduced patient morbidity, abbreviated postoperative recovery periods, and lesser risks of iatrogenic-induced pain due to potential neuroma formation. In particular, the preservation of neural and muscular structures contributes to prompt and favorable outcomes. The greater and lesser occipital nerves can be exposed and decompressed via the described approach. For the purpose of this paper, only greater occipital nerve decompression is described to improve occipital neuralgia, which is due to lesser occipital neuralgia. The third occipital nerve is responsible for rare cases of occipital neuralgia in our practice, which are addressed with a separate approach due to its medial localization. The described technique includes the systematic exploration of the passage of the greater occipital nerve through the semispinalis capitis which may represent a compression point. Further research and clinical validation are warranted to ascertain the full scope of its efficacy and safety.

<meta charset="utf8"></head><body>作者聚焦：微创缓解颈项线枕神经痛

枕神经微创手术减压术

Occipital neuralgia (ON) stands out as one of the most distressing forms of headache disorders, distinguished by persistent pain at the base of the skull, ...

minimally-invasive-surgical-decompression-of-occipital-nerves

Research

JoVE Journal

Medicine

Minimally Invasive Surgical Decompression of Occipital Nerves

1.1K 次观看.  Global Medical Institute. 我们的目标是通过微创方法解决枕神经痛问题，以保持肌肉和神经等结构的完整性。我们将枕神经痛减压手术和腕管减压手术相提并论。我们可以通过微创手术来改善枕神经痛，让患者立即从手术中恢复过来。我们的方法为越来越多的枕神经痛患者提供了一种有效的解决方案。我们希望能够在不久的将来诊断和治疗枕神经痛，就像我们对腕管综...

视频: 作者聚焦：微创缓解颈项线枕神经痛

Occipital neuralgia (ON) stands out as one of the most distressing forms of headache disorders, distinguished by persistent pain at the base of the skull, recurring occipital headaches, and scalp dysesthesia or allodynia. ON is notorious for its unrelenting agony, severely impacting the lives of those afflicted. The incessant pain, often radiating upward from the base of the skull to the scalp, can be profoundly debilitating. Patients frequently endure excruciating occipital headaches, making even routine daily activities a formidable challenge. The added burden of scalp dysesthesia or allodynia, where seemingly innocuous stimuli elicit severe pain, compounds the suffering. This neuralgia primarily arises from the mechanical compression exerted on the occipital nerves along the nuchal line. In this paper, we present a minimally invasive nerve and muscle-preserving technique aimed at relieving this compression on the occipital nerves. Accurate diagnosis and effective treatment are paramount in providing relief for individuals battling this condition. Nerve blocks with local anesthesia have become a cornerstone of diagnosis, serving as both a confirmation of occipital neuralgia and a potential therapeutic intervention. These procedures offer crucial insights into the source of the pain while offering transient respite. However, the true breakthrough lies in the innovative technique we propose - a procedure that addresses the mechanical compression at the nuchal line, which is a prominent contributing factor to occipital neuralgia. By carefully decompressing the affected occipital nerves while preserving their integrity and surrounding muscle tissue, this minimally invasive approach offers patients a potential path to sustained relief. Remarkably, the procedure can be performed under local anesthesia, reducing the invasiveness of traditional surgeries and minimizing patient downtime.

The manuscript presents a minimally invasive nerve and muscle-sparing surgical protocol to decompress occipital nerves aiming to improve occipital neuralgia.