Surgical anatomy of greater occipital nerve and its relation to occipital artery

Here we report a unique case of chronic occipital neuralgia caused by pathological vascular contact of the left greater occipital nerve. After 12 months of left-sided, unremitting occipital neuralgia, a hypesthesia and facial pain developed in the left hemiface. The decompression of the left greater occipital nerve from pathological contacts with the occipital artery resulted in immediate relief for hemifacial sensory change and facial pain, as well as chronic occipital neuralgia. Although referral of pain from the stimulation of occipital and cervical structures innervated by upper cervical nerves to the frontal head of V1 trigeminal distribution has been reported, the development of hemifacial sensory change associated with referred trigeminal pain from chronic occipital neuralgia is extremely rare. Chronic continuous and strong afferent input of occipital neuralgia caused by pathological vascular contact with the greater occipital nerve seemed to be associated with sensitization and hypersensitivity of the second-order neurons in the trigeminocervical complex, a population of neurons in the C2 dorsal horn characterized by receiving convergent input from dural and cervical structures.

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Hemifacial Trigeminal Pain Referred from Occipital Neuralgia Due to Compression of the Greater Occipital Nerve by the Occipital Artery

Journal of Neurological Surgery Part A Central European Neurosurgery ◽

10.1055/s-0038-1655751 ◽

2018 ◽

Vol 79 (05) ◽

pp. 442-446 ◽

Cited By ~ 5

Author(s):

Hak-cheol Ko ◽

Jin-gyu Choi ◽

Byung-chul Son

Keyword(s):

Spatial Relationship ◽

Occipital Artery ◽

Occipital Neuralgia ◽

Occipital Nerve ◽

Trigeminal Pain ◽

Nociceptive Pathways ◽

Greater Occipital Nerve ◽

Subcutaneous Layer ◽

High Cervical ◽

Crossing Point

Although pathologic vascular contact between the occipital artery and the greater occipital nerve (GON) at the crossing point in the nuchal subcutaneous layer can cause occipital neuralgia, referred hemifacial trigeminal pain from chronic occipital neuralgia owing to this cause is extremely rare.A 61-year-old female patient with left-sided occipital neuralgia for 4 years presented with a new onset of left-sided hemifacial pain. Decompression of the left GON from pathologic contacts with the occipital artery resulted in immediate relief for hemifacial pain and chronic occipital neuralgia. The present case implies that sensitization and hyperactivity of the trigeminocervical complex that receives the convergent input from trigeminal and high cervical occipital nociceptive pathways can be a pathogenic mechanism in referred hemifacial pain from occipital neuralgia. In the present case, a branching tributary of the occipital artery at the crossing point forming a constricting loop above the course of the GON was found to be the cause of entrapment. Because the occipital artery is reported to be consistently located superficial to the GON at the crossing point, a spatial relationship between the occipital artery and the GON rather than a mere adhesion or contact might have pathologic significance in the development of occipital neuralgia.

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Ultrasound Scan of the Occipital and Upper Cervical Region

10.30756/ahmj.2020.01.04 ◽

2019 ◽

Author(s):

Sergi Boada Pie

Keyword(s):

Vertebral Artery ◽

Cervical Region ◽

Posterior Arch ◽

Occipital Artery ◽

Cranial Ultrasound ◽

Ultrasound Scan ◽

Great Occipital Nerve ◽

Occipital Nerve ◽

Greater Occipital Nerve ◽

Upper Cervical

The sonoanatomical knowledge of the upper cervical and occipital region is critical for the identification of structures involved in the pathophysiology of cervicogenic headache and neck pain. We propose a systematic caudo-cranial ultrasound scan using a paramedial transverse view. The first relevant structure to identify is the Obliquus Capitis Inferior Muscle (OCIM) that in turn will allow us to locate the Great Occipital Nerve (GON), the C1-C2 joint, the C2 dorsal root ganglion, medial to the joint, and the Vertebral Artery, lateral to the joint. Sonogram 1 demonstrates the great occipital nerve (GON) between the seminspinalis capitus muscle (SMCEM) and obliquus Capitis Inferior Muscle (OCIM) and the C1-C2 joint. Aligning the transducer obliquely along the long axis of the OCIM, may allow for better visualization of the muscle. With a cranial displacement of the probe, one can identify the posterior arch of C1 and the vertebral artery as it transverses from lateral to medial crossing the medial posterior aspect of the atlanto-occipital joint (sonograms 2 and 3). Finally, with more cranial scan, one can identify the occipital bone and the occipital artery near the distal branches of the greater occipital nerve and third occipital nerve more medially (Sonogram 4). With continued cranial scanning the GON will be more superficial as it pierces the trapezius aponeurosis.

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