Single Incision Approach for Decompression of Greater, Lesser and Third Occipital Nerves in Migraine Surgery

Abstract Background The traditional approach for occipital migraine surgery encompasses 3 separate surgical incisions in the posterior neck to decompress the great occipital nerves (GON), lesser occipital nerves (LON) and third occipital nerves (TON). We sought to evaluate a single midline incision approach for decompression of all 6 occipital nerves. Methods Using 10 cadaveric hemi-sides (5 fresh cadaver head and necks). Anatomic landmarks and the location of the bilateral GON, LON and TON were marked according to previous anatomic studies. A single midline 9-cm incision was made and lateral skin flaps were raised to decompress or avulse all 6 nerves. Results The GON and TON were identified 3.5 and 6.2 cm, respectively inferior to a line bisecting the external auditory canal (EAC) and 1.5 cm lateral to the midline. The LON was identified 6-cm inferior and 6.5-cm medial to a line bisecting the EAC in the plane just above the investing layer of the deep cervical fascia until the posterior boarder of the sternocleidomastoid was encountered. The LON had the greatest amount of variation, but was identified lateral to the posterior border of the SCM. Conclusions A single midline incision approach allows for successful identification and decompression of all 6 occipital nerves in migraine surgery.