Muscle Fascia Changes in Patients with Occipital Neuralgia, Headache, or Migraine.
Adolescent
Adult
Child
Child, Preschool
Decompression, Surgical
/ methods
Fascia
/ pathology
Fasciotomy
Female
Fibrosis
Headache
/ etiology
Humans
Male
Middle Aged
Migraine Disorders
/ etiology
Nerve Compression Syndromes
/ complications
Neuralgia
/ etiology
Occipital Lobe
/ pathology
Prospective Studies
Spinal Nerves
/ pathology
Treatment Outcome
Trigger Points
Young Adult
Journal
Plastic and reconstructive surgery
ISSN: 1529-4242
Titre abrégé: Plast Reconstr Surg
Pays: United States
ID NLM: 1306050
Informations de publication
Date de publication:
01 01 2021
01 01 2021
Historique:
entrez:
28
12
2020
pubmed:
29
12
2020
medline:
28
4
2021
Statut:
ppublish
Résumé
In an ongoing effort to understand the pathogenesis of occipital neuralgia/headache/migraine, it is critical to describe the anatomical/tissue changes encountered during surgery. Greater occipital nerve anatomical studies mainly focus on the greater occipital nerve course through muscle/fascial planes and interaction with the occipital vessels. However, structural soft-tissue changes have not been described in detail. Anecdotally, trapezius fascia is thickened at the greater occipital nerve trigger site. This study further investigates this observation. Patients undergoing greater occipital nerve decompression surgery were enrolled prospectively in this observational study (n = 92). Tissue changes were recorded intraoperatively. The resulting data were examined. Trapezius fascia was more than 3 mm thick and appeared fibrotic in 86 patients (94 percent), whereas semispinalis muscle appeared normal in all subjects. The greater occipital nerve was macroscopically abnormal, defined as edematous, flattened, and discolored in 29 cases (32 percent). The occipital artery interacted significantly with the greater occipital nerve in 88 percent of cases. The authors conclude that the tissue structure is abnormal in patients undergoing greater occipital nerve decompression surgery. This is the first study that describes the prevalence of thickened and fibrotic appearing trapezius fascia at the occipital trigger site, a phenomenon encountered in the vast majority of patients (94 percent). This structural anomaly has a resemblance to thickened fascial tissues seen in other nerve compression syndromes, and could be related to microtrauma/overuse or actual trauma in the head and neck region.
Identifiants
pubmed: 33370063
doi: 10.1097/PRS.0000000000007484
pii: 00006534-202101000-00034
doi:
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
176-180Commentaires et corrections
Type : CommentIn
Type : CommentIn
Type : CommentIn
Type : CommentIn
Type : CommentIn
Type : CommentIn
Informations de copyright
Copyright © 2020 by the American Society of Plastic Surgeons.
Déclaration de conflit d'intérêts
Disclosure:The authors have no conflicts of interest to disclose. None of the authors has a financial interest in any of the products or devices mentioned in this article.
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