ANATOMIC VARIATIONS IN OCCIPITAL NERVES
A couple of days ago I had another interesting case that highlights the variations in anatomy of the occipital nerves that we see from time to time. In the 1st picture, we see the classic anatomy of the right, greater occipital nerve (white arrow) which has now been decompressed from the surrounding semispinalis muscle. You can easily see the intact vasa nervorum (those red lines within the nerve which represent intact blood vessels indicating a healthy nerve. On the left side, you can see a bifurcated (i.e. split) greater occipital nerve with two branches (grey arrows) and an intervening piece of semispinalis muscle (the two thin black lines).
In the 2nd and 3rd pictures the intervening piece of semispinalis muscle is retracted medially (picture 2) and laterally (picture 3) to better demonstrate the two branches of the left GON. In the 4th picture, the intervening piece of semispinalis muscle has been removed and the two branches of the left GON are now meeting at a main trunk (white arrow). This case demonstrates that phrase I often tell my patients which is that “everyone is literally wired differently”. I hope you like these case presentations and that they are instructive as well as helpful in understanding the anatomy involved.
Click Photos To Enlarge.
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