title: An anatomical study of the lesser occipital nerve and its potential compression points: implications for surgical treatment of migraine headaches.
abstract: BACKGROUND
  This study maps the course of the lesser occipital nerve and its potential compression sites in the posterior scalp.
  
  
  METHODS
  Twenty sides of 10 fresh cadaveric heads were dissected. Two fixed anatomical landmarks were used: the y axis was the vertical midline in the posterior scalp through the midline of the cervical spine. The x axis was a horizontal line drawn between the most anterosuperior points of the external auditory meatus. A topographic map of the lesser occipital nerve and its potential compression points was created.
  
  
  RESULTS
  The lesser occipital nerve emerged from the posterior border of the sternocleidomastoid muscle at an average of 6.4 ± 1.4 cm lateral to the y axis and 7.5 ± 0.9 cm caudal to the x axis. Branches of the occipital artery were found to interact with the lesser occipital nerve in 11 of the 20 hemiheads (55 percent). The mean location of the artery-nerve interaction was 5.1 ± 0.9 cm lateral to the y axis and 2 ± 1.45 cm caudal to the x axis. Two patterns of artery-nerve interaction were seen: a single site of artery crossing over the nerve in nine of 20 hemiheads (45 percent) and a helical intertwining relationship in two of 20 of hemiheads (10 percent). A fascial band was identified to compress the lesser occipital nerve in four of 20 hemiheads (20 percent).
  
  
  CONCLUSIONS
  This anatomical study traced the lesser occipital nerve as it courses through the posterior scalp and mapped its potential decompression sites.
authors.affiliation: Cleveland, Ohio From the Department of Plastic and Reconstructive Surgery, Case Western Reserve University.
authors.forename: Michelle
authors.initials: M
authors.lastname: Lee
authors.forename: Matthew
authors.initials: M
authors.lastname: Brown
authors.forename: Kyle
authors.initials: K
authors.lastname: Chepla
authors.forename: Haruko
authors.initials: H
authors.lastname: Okada
authors.forename: James
authors.initials: J
authors.lastname: Gatherwright
authors.forename: Ali
authors.initials: A
authors.lastname: Totonchi
authors.forename: Brendan
authors.initials: B
authors.lastname: Alleyne
authors.forename: Samantha
authors.initials: S
authors.lastname: Zwiebel
authors.forename: David
authors.initials: D
authors.lastname: Kurlander
authors.forename: Bahman
authors.initials: B
authors.lastname: Guyuron
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D059925:Anatomic Landmarks; D002102:Cadaver; D002574:Cervical Vertebrae / Q000294:innervation; D019299:Decompression, Surgical; D006801:Humans; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000209:etiology / Q000601:surgery*; D009408:Nerve Compression Syndromes / Q000150:complications / Q000601:surgery*; D012535:Scalp / Q000294:innervation; D013127:Spinal Nerves / Q000033:anatomy & histology* / Q000601:surgery*