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Takamitsu Fujimaki - One of the best experts on this subject based on the ideXlab platform.
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preservation of the Lesser Occipital Nerve prevents Occipital sensory disturbance after microvascular decompression long term results
World Neurosurgery, 2020Co-Authors: Sachiko Hirata, Masahito Kobayashi, Kenji Wakiya, Takamitsu FujimakiAbstract:Background In microvascular decompression (MVD) surgery for hemifacial spasm (HFS), preservation of the Lesser Occipital Nerve (LON) will prevent Occipital sensory disturbance, a frequent complication of MVD, but the long-term outcome is unknown. This study was designed to evaluate the long-term efficacy of LON preservation. Methods This retrospective study included 257 patients with HFS who underwent subOccipital craniotomy with MVD. Among them, 175 were followed-up for more than 2 years. Occipital sensation was examined at 1, 12, and 24 months after MVD. The patients were classified into 3 groups based on their operative findings: LON preservation (group A; n = 112), LON not identified (group B; n = 117), and LON excision (group C; n = 28). The degree of sensory disturbance was evaluated using a visual analog scale (VAS) ranging from 1 (no sensation) to 10 (intact). Results The VAS score at 1 month was significantly better in group B (7.9 ± 0.2) than in groups A and C (7.3 ± 0.2 and 6.8 ± 0.4, respectively). At 24 months, the VAS scores were significantly higher in groups A and B (9.7 ± 0.1 and 9.7 ± 0.1) than in group C (8.8 ± 0.4), and Occipital scalp sensation remained intact (VAS scores 9 and 10) in 91.9%, 92.9%, and 62.5% of the patients in groups A, B and C, respectively. Conclusions Our long follow-up study has demonstrated that preservation of the LON during MVD prevents sensory disturbance of the Occipital scalp. Efforts to preserve the LON appear to be worthwhile when the subOccipital approach is chosen.
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preservation of the Lesser Occipital Nerve during microvascular decompression for hemifacial spasm technical note
Journal of Neurosurgery, 2007Co-Authors: Takamitsu Fujimaki, Shigehiko Takanashi, Teruyuki Ishii, Kazuhide Furuya, Toshihiro Mochizuki, Toshiaki Ueno, Tadayoshi NakagomiAbstract:✓The authors report on their technique for preserving the Lesser Occipital Nerve (LON) during lateral subOccipital craniotomy. In their technique, the LON, which runs along the surface of or just beneath the sternocleidomastoid muscle, is identified and preserved. Lesser Occipital Nerve preservation using their technique was attempted in 25 patients who underwent microvascular decompression for hemifacial spasm. The LON was successfully preserved in 16 of these patients, was impossible to preserve in two patients, and could not be identified in seven patients. Among the patients in whom LON preservation was successful, 87.5% were free of sensory disturbance 6 months after surgery, whereas both patients in whom the LON could not be preserved complained of sensory disturbances in the Occipital area and the posterior part of the auricula. Fifty-seven percent of the patients whose LON could not be identified complained of sensory disturbance. Thus, this technique for preserving the LON reduces the incidence o...
Doris Liebasamal - One of the best experts on this subject based on the ideXlab platform.
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the Lesser Occipital Nerve visualized by high resolution sonography normal and initial suspect findings
Cephalalgia, 2015Co-Authors: Hannes Platzgummer, Thomas Moritz, G M Gruber, Christopher Pivec, Christian Wober, Gerd Bodner, Doris LiebasamalAbstract:BackgroundThe Lesser Occipital Nerve (LON) supplies the lateral part of the occiput and is—together with the greater Occipital Nerve (GON)—involved in headache pathogenesis. While the GON was described in high-resolution ultrasound (HRUS), the same does not apply to the LON. We aimed at characterizing the LON in HRUS, and present cases of suspect findings in the course of the LON identified by HRUS.MethodsThe LON was examined bilaterally in eight anatomical specimens with HRUS (n = 16). HRUS-guided ink marking and consecutive dissection was performed. Further, measurements of the LON diameter were performed in 10 healthy volunteers (n = 20), and patient charts were reviewed to identify patients who were considered to have possible pathology of the LON.ResultsThe LON was identified correctly in all cadavers on both sides and all volunteers except for one side (n = 19). The average diameter was 1.08 ± 0.30 mm. Four patients with pain within the LON territory and presumed peripheral origin of headache (defin...
Hannes Platzgummer - One of the best experts on this subject based on the ideXlab platform.
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the Lesser Occipital Nerve visualized by high resolution sonography normal and initial suspect findings
Cephalalgia, 2015Co-Authors: Hannes Platzgummer, Thomas Moritz, G M Gruber, Christopher Pivec, Christian Wober, Gerd Bodner, Doris LiebasamalAbstract:BackgroundThe Lesser Occipital Nerve (LON) supplies the lateral part of the occiput and is—together with the greater Occipital Nerve (GON)—involved in headache pathogenesis. While the GON was described in high-resolution ultrasound (HRUS), the same does not apply to the LON. We aimed at characterizing the LON in HRUS, and present cases of suspect findings in the course of the LON identified by HRUS.MethodsThe LON was examined bilaterally in eight anatomical specimens with HRUS (n = 16). HRUS-guided ink marking and consecutive dissection was performed. Further, measurements of the LON diameter were performed in 10 healthy volunteers (n = 20), and patient charts were reviewed to identify patients who were considered to have possible pathology of the LON.ResultsThe LON was identified correctly in all cadavers on both sides and all volunteers except for one side (n = 19). The average diameter was 1.08 ± 0.30 mm. Four patients with pain within the LON territory and presumed peripheral origin of headache (defin...
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The Lesser Occipital Nerve visualized by high-resolution sonography—normal and initial suspect findings:
Cephalalgia, 2014Co-Authors: Hannes Platzgummer, Thomas Moritz, G M Gruber, Christopher Pivec, Christian Wober, Gerd Bodner, Doris Lieba-samalAbstract:BackgroundThe Lesser Occipital Nerve (LON) supplies the lateral part of the occiput and is—together with the greater Occipital Nerve (GON)—involved in headache pathogenesis. While the GON was described in high-resolution ultrasound (HRUS), the same does not apply to the LON. We aimed at characterizing the LON in HRUS, and present cases of suspect findings in the course of the LON identified by HRUS.MethodsThe LON was examined bilaterally in eight anatomical specimens with HRUS (n = 16). HRUS-guided ink marking and consecutive dissection was performed. Further, measurements of the LON diameter were performed in 10 healthy volunteers (n = 20), and patient charts were reviewed to identify patients who were considered to have possible pathology of the LON.ResultsThe LON was identified correctly in all cadavers on both sides and all volunteers except for one side (n = 19). The average diameter was 1.08 ± 0.30 mm. Four patients with pain within the LON territory and presumed peripheral origin of headache (defin...
Constance Cottrell - One of the best experts on this subject based on the ideXlab platform.
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Botulinum toxin type-A (BOTOX®) in the treatment of Occipital neuralgia: A pilot study
Headache, 2008Co-Authors: Martin Taylor, Sachin Silva, Constance CottrellAbstract:OBJECTIVE: To determine the efficacy of Occipital Nerve blocks using reconstituted botulinum toxin type-A (BTX-A) in providing significant and prolonged pain relief in chronic Occipital neuralgia. BACKGROUND: Occipital neuralgia is a unilateral or bilateral radiating pain with paresthesias commonly manifesting as paroxysmal episodes and involving the Occipital and parietal regions. Common causes of Occipital neuralgia include irritation or injury to the divisions of the Occipital Nerve, myofascial spasm, and focal entrapment of the Occipital Nerve. Treatment options include medication therapy, Occipital Nerve blocks, and surgical techniques. BTX-A, which has shown promise in relief of other headache types, may prove a viable therapeutic option for Occipital neuralgia pain. METHODS: Botulinum toxin type-A (reconstituted in 3 cc of saline) was injected into regions traversed by the greater and Lesser Occipital Nerve in 6 subjects diagnosed with Occipital neuralgia. Subjects were instructed to report their daily pain level (on a visual analog pain scale), their ability to perform daily activities (on several quality of life instruments) and their daily pain medication usage (based on a self-reported log), 2 weeks prior to the injection therapy and 12 weeks following injection therapy. Data were analyzed for significant variation from baseline values. RESULTS: The dull/aching and pin/needles types of pain reported by the subjects did not show a statistically significant improvement during the trial period. The sharp/shooting type of pain, however, showed improvement during most of the trial period except weeks 3-4 and 5-6. The quality of life measures exhibited some improvement. The headache-specific quality of life measure showed significant improvement by 6 weeks which continued through week 12. The general health- and depression-related measures showed no statistical improvement. No significant reduction in pain medication usage was demonstrated. CONCLUSIONS: Our results indicate that BTX-A improved the sharp/shooting type of pain most commonly known to be associated with Occipital neuralgia. Additionally, the quality of life measures assessing burden and long-term impact of the headaches, further corroborated improvement seen in daily head pain.
Amir H Dorafshar - One of the best experts on this subject based on the ideXlab platform.
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surgical safe zone rapid anatomical identification of the Lesser Occipital Nerve
Journal of Reconstructive Microsurgery, 2019Co-Authors: Nima Khavanin, Hannah M Carl, Robin Yang, Amir H DorafsharAbstract:Background Surgical intervention has established a vital role in the management of chronic headaches. The Lesser Occipital Nerve (LON) is a common target in patients suffering from Occipital neuralgia and is often resected as a first-line option. We endeavored to define the relationships of the LON in the posterolateral neck to facilitate its safe and rapid intraoperative identification. Methods Seven fresh cadavers (14 Nerves) were dissected, and their relationships to the mastoid prominence and nearby spinal accessory Nerve (SAN) and greater auricular Nerve were noted. Results The distance from the mastoid to the emergence of the LON along the posterior sternocleidomastoid ranged from 36 to 51 mm (mean: 45.2 mm), with relative symmetry between the two Nerves in the same cadaver. The SAN emerged an average of 54 mm from the mastoid prominence. Conclusion Exploration for the LON should begin at a point 40 mm from the mastoid prominence along the posterior border of the sternocleidomastoid muscle. If the point of exit of the LON is not identified within 10 mm of this exposure, our dissection continues cranially along the posterior border of the sternocleidomastoid, anterior to the trapezius. In rare cases the Nerve may pierce the fibers of the muscle and ascend directly on top of the muscle belly. By limiting the caudal extend of the dissection, we can avoid exposure of the SAN and minimize the risk of iatrogenic Nerve injury.
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Surgical "Safe Zone": Rapid Anatomical Identification of the Lesser Occipital Nerve.
Journal of reconstructive microsurgery, 2018Co-Authors: Nima Khavanin, Hannah M Carl, Robin Yang, Amir H DorafsharAbstract:Surgical intervention has established a vital role in the management of chronic headaches. The Lesser Occipital Nerve (LON) is a common target in patients suffering from Occipital neuralgia and is often resected as a first-line option. We endeavored to define the relationships of the LON in the posterolateral neck to facilitate its safe and rapid intraoperative identification. Seven fresh cadavers (14 Nerves) were dissected, and their relationships to the mastoid prominence and nearby spinal accessory Nerve (SAN) and greater auricular Nerve were noted. The distance from the mastoid to the emergence of the LON along the posterior sternocleidomastoid ranged from 36 to 51 mm (mean: 45.2 mm), with relative symmetry between the two Nerves in the same cadaver. The SAN emerged an average of 54 mm from the mastoid prominence. Exploration for the LON should begin at a point 40 mm from the mastoid prominence along the posterior border of the sternocleidomastoid muscle. If the point of exit of the LON is not identified within 10 mm of this exposure, our dissection continues cranially along the posterior border of the sternocleidomastoid, anterior to the trapezius. In rare cases the Nerve may pierce the fibers of the muscle and ascend directly on top of the muscle belly. By limiting the caudal extend of the dissection, we can avoid exposure of the SAN and minimize the risk of iatrogenic Nerve injury. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.