| Occipital artery vasculitis not identified as a mechanism of occipital neuralgia-related chronic migraine headaches. | |
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MedLine Citation:
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PMID: 21921766 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Recent evidence has shown that some cases of occipital neuralgia are attributable to musculofascial compression of the greater occipital nerve and improve with neurolysis. A mechanical interaction at the intersection of the nerve and the occipital artery may also be capable of producing neuralgia, although that mechanism remains one theoretical possibility among several. The authors evaluated the possibility of unrecognized vasculitis of the occipital artery as a potential mechanism of occipital neuralgia arising from the occipital artery/greater occipital nerve junction. METHODS: Twenty-five patients with preoperatively documented bilateral occipital neuralgia-related chronic headaches underwent peripheral nerve surgery with decompression of the greater occipital nerve bilaterally, including the area of its intersection with the occipital artery. In 15 patients, a 2-cm segment of the occipital artery was excised and submitted for pathologic evaluation. All patients were evaluated intraoperatively for evidence of arterially mediated greater occipital nerve compression, and the configuration of the nerve-vessel intersection was noted. RESULTS: None of the 15 specimens submitted for pathologic evaluation showed vasculitis. Intraoperatively, all 50 sites examined showed an intimate physical association between the occipital artery and greater occipital nerve. CONCLUSIONS: Surgical specimens from this first in vivo study provided no histologic evidence of vasculitis as a cause of greater occipital nerve irritation at the occipital artery/greater occipital nerve junction in patients with chronic headaches caused by occipital neuralgia. Based on these findings, mechanical (and not primary inflammatory) irritation of the nerve by the occipital artery remains an important theoretical cause for otherwise idiopathic cases. The authors have adopted an operative technique that includes physical separation of the nerve-artery intersection (in addition to musculofascial neurolysis) for a more thorough surgical treatment of occipital neuralgia. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV. |
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Authors:
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Ivica Ducic; John M Felder; Jeffrey E Janis |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Plastic and reconstructive surgery Volume: 128 ISSN: 1529-4242 ISO Abbreviation: Plast. Reconstr. Surg. Publication Date: 2011 Oct |
Date Detail:
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Created Date: 2011-09-16 Completed Date: 2011-11-09 Revised Date: 2012-09-10 |
Medline Journal Info:
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Nlm Unique ID: 1306050 Medline TA: Plast Reconstr Surg Country: United States |
Other Details:
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Languages: eng Pagination: 908-12 Citation Subset: AIM; IM |
Affiliation:
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Department of Plastic Surgery, Peripheral Nerve Surgery Institute, Georgetown University Hospital, Washington, DC 20007, USA. ducici@gunet.georgetown.edu |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Cohort Studies Follow-Up Studies Headache Disorders / etiology, physiopathology, surgery Humans Immunohistochemistry Male Migraine Disorders / etiology, physiopathology, surgery* Neuralgia / etiology, physiopathology, surgery* Neurosurgical Procedures / methods Occipital Bone / blood supply*, innervation Preoperative Care / methods Severity of Illness Index Treatment Outcome Vasculitis / complications, diagnosis* |
| Comments/Corrections | |
Comment In:
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Plast Reconstr Surg. 2011 Oct;128(4):915-7
[PMID:
21921768
]
Plast Reconstr Surg. 2011 Oct;128(4):913-4 [PMID: 21921767 ] |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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