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J Neurol Surg B Skull Base 2012; 73(04): 221-224
DOI: 10.1055/s-0032-1312708
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Modified Wound Dissection Preserving the Greater Occipital Nerve in Foramen Magnum Decompression: A Technique to Reduce Postoperative Pain

Satoru Shimizu
1   Department of Neurosurgery, Yokohama Stroke and Brain Center, Yokohama, Kanagawa, Japan
,
Tomoya Yamazaki
1   Department of Neurosurgery, Yokohama Stroke and Brain Center, Yokohama, Kanagawa, Japan
,
Koji Kondo
1   Department of Neurosurgery, Yokohama Stroke and Brain Center, Yokohama, Kanagawa, Japan
,
Satoshi Utsuki
2   Department of Neurosurgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
,
Hidehiro Oka
2   Department of Neurosurgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
,
Kenji Nakayama
1   Department of Neurosurgery, Yokohama Stroke and Brain Center, Yokohama, Kanagawa, Japan
,
Isao Yamamoto
1   Department of Neurosurgery, Yokohama Stroke and Brain Center, Yokohama, Kanagawa, Japan
,
Kiyotaka Fujii
2   Department of Neurosurgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
› Author Affiliations
Further Information

Publication History

18 July 2011

29 December 2011

Publication Date:
14 June 2012 (online)

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Abstract

Patients undergoing foramen magnum decompression for Chiari malformation may experience severe postoperative pain in the area innervated by the greater occipital nerve (GON). We developed a modified dissection to lessen this pain. A midline skin incision was extended 2 cm in a cephalad direction to the inion and the skin was minimally retracted. After exposing the occipital bone, the semispinalis capitis and the trapezius muscles were detached subperiosteally in a caudal-to-cephalad direction. Consequently, the muscles and skin containing the GON were retracted in a single layer. We retrospectively compared the intensity of postoperative pain recorded on the visual analogue scale (VAS) by patients who underwent decompression using our (group A, n = 5) and the conventional layer-by-layer dissection technique (group B, n = 5). The VAS scores were not different on the day of surgery, but subsequently they fell faster in group A. Group A patients received a mild analgesic for a short period. Group B patients required a stronger analgesic for prolonged periods. Postoperative GON numbness/tenderness was observed only in group B. With respect to most evaluation criteria, the difference between the two groups was significant. Our anatomically rational dissection that protects the GON results in less postoperative pain.

Keywords

foramen magnum decompression - greater occipital nerve - postoperative pain
 

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