title: Can proximity of the occipital artery to the greater occipital nerve act as a cause of idiopathic greater occipital neuralgia? An anatomical and histological evaluation of the artery-nerve relationship.
abstract: BACKGROUND
  The purpose of this study was to clarify whether proximity of the occipital artery to the greater occipital nerve can act as a cause of occipital neuralgia, analogous to the contribution of intracranial vessels due to compression in cranial nerve neuralgias, represented by trigeminal neuralgias due to compression of the trigeminal nerve root by adjacent arterial loops.
  
  
  METHODS
  Twenty-four suboccipital areas in cadaver heads were studied for anatomical relationships between the occipital artery and the greater occipital nerve, with histopathological assessment of the greater occipital nerve for signs of mechanical damage.
  
  
  RESULTS
  The occipital artery and greater occipital nerve were found to cross each other in the nuchal subcutaneous layer, and the latter was constantly situated superficial to the former at the cross point. An indentation of the greater occipital nerve due to the occipital artery was observed at the cross point in all specimens. However, histopathological examination did not reveal any findings of damage to nerves, even in specimens with atherosclerosis of the occipital artery.
  
  
  CONCLUSIONS
  Although the present study did not provide direct evidence that the occipital artery contributes to occipital neuralgia at the point of contact with the greater occipital nerve, the possibility still cannot be precluded, because the occipital artery may be palpable in areas corresponding to tenderness of the greater occipital nerve. Further studies, including clinical cases, are needed to clarify this issue.
authors.affiliation: Sagamihara and Kawasaki, Kanagawa, Tokyo From the Department of Neurosurgery, Kitasato University School of Medicine, and Tanaka Clinic.
authors.forename: Satoru
authors.initials: S
authors.lastname: Shimizu
authors.forename: Hidehiro
authors.initials: H
authors.lastname: Oka
authors.forename: Shigeyuki
authors.initials: S
authors.lastname: Osawa
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Fukushima
authors.forename: Satoshi
authors.initials: S
authors.lastname: Utsuki
authors.forename: Ryusui
authors.initials: R
authors.lastname: Tanaka
authors.forename: Kiyotaka
authors.initials: K
authors.lastname: Fujii
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002102:Cadaver; D005260:Female; D006257:Head / Q000033:anatomy & histology* / Q000098:blood supply* / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009408:Nerve Compression Syndromes / Q000209:etiology*; D009437:Neuralgia / Q000209:etiology*