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Master Thesis

Étude anatomique du nerf grand occipital en vue d'optimiser les voies d'abord de la fosse crânienne postérieure

Abstract : Purpose: because of its superficial location in the dorsal regions of the scalp, the greater occipital nerve (GON) can be injured during neurosurgical procedures, resulting in post-operative morbidity. The aim of this work is to specify the course of the GON and how its injuries can be avoided while performing posterior fossa approaches. Methods: this study was carried out at the department of anatomy in Bordeaux University. 5 specimens were dissected to study the GON course. 4 others specimens were used to perform posterior fossa approaches (midline suboccipital approach, paramedian suboccipital approach, retrosigmoid approach and petrosal approach), with an assessment of potential injuries to the GON. Results: the GON runs around the obliquus capitis inferior (100%), crosses the semispinalis capitis (100%) and the trapezius (75%) or its aponeurosis (25%). Direct GON injuries were observed in paramedian suboccipital approaches. Indirect GON injuries due its stretching can occur in midline suboccipital and paramedian suboccipital approaches. We did not find any evidence of direct or indirect GON injury in retrosigmoid or petrosal approaches. Conclusion: our study provides interesting data regarding the risk GON injury in posterior fossa approaches. Direct GON injuries in paramedian suboccipital approaches can be avoided with careful dissection. Placing retractors in contact with the periosteum and performing a minimal retraction may help to avoid excessive GON stretching in midline suboccipital and paramedian suboccipital approaches. Furthermore, incision for retrosigmoid approaches should be as lateral as possible and not too caudal. Finally, avoiding extreme patient positioning might reduce the risk of per operative GON stretching.
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https://dumas.ccsd.cnrs.fr/dumas-03355123
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Submitted on : Monday, September 27, 2021 - 10:44:22 AM
Last modification on : Saturday, October 23, 2021 - 3:24:39 AM

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  • HAL Id : dumas-03355123, version 1

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Gaétan Lainé. Étude anatomique du nerf grand occipital en vue d'optimiser les voies d'abord de la fosse crânienne postérieure. Sciences du Vivant [q-bio]. 2021. ⟨dumas-03355123⟩

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