gms | German Medical Science

63rd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Japanese Neurosurgical Society (JNS)

German Society of Neurosurgery (DGNC)

13 - 16 June 2012, Leipzig

Greater occipital nerve: anatomical considerations and clinical implications

Meeting Abstract

  • O. Müller - Klinik für Neurochirurgie, Universitätsklinikum Essen
  • V. Hagel - Klinik für Neurochirurgie, Universitätsklinikum Essen
  • C. Gaul - Klinik für Neurologie, Westdeutsches Kopfschmerzzentrum, Universitätsklinikum Essen
  • H.P. Hohn - Institut für Anatomie, Universitätsklinikum Essen
  • U. Sure - Klinik für Neurochirurgie, Universitätsklinikum Essen

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 63. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie (JNS). Leipzig, 13.-16.06.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. DocFR.11.08

doi: 10.3205/12dgnc262, urn:nbn:de:0183-12dgnc2626

Published: June 4, 2012

© 2012 Müller et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Objective: Stimulation of the greater occipital nerve (GON) is an effective method of treatment for various intractable headache conditions. To assess whether the placement of the electrodes and the extent of the stimulation corresponds to the clinical effect of the therapy, we conducted a study on the course of the GON traversing the trapezius muscle in human cadavers and, furthermore, correlated the postoperative X-rays of electrodes placement in nineteen patients with chronic cluster headaches with their response to the stimulation of the GON.

Methods: Ten formalin fixed human cadavers were dissected to identify the passage of the GON through the trapezius muscle. The distance to the external occipital protuberance was triangulated measuring the distance of the nerve from the nuchal midline and the protuberance. The mean distance was correlated to the lead placement on postoperative x-rays of nineteen patients treated for refractory chronic cluster headaches. The field of the individual stimulation was further correlated to the response of the patients to the stimulation with regard to reduction of daily cluster attacks and relief of intensity at the three-month follow-up.

Results: In the anatomical subjects, the GON passed the trapezius muscle at a mean distance of 31 mm below the external occipital protuberance and 14 mm lateral to the midline at the level of the atlas. The placement of the electrodes was targeted at this level in all of our patients documented by postoperative x-ray and stimulated the GON in all patients. Sixteen of the patients reported a significant relief of their cluster attacks and / or decreased intensity of pain during the attacks. Yet, three of nineteen patients did not benefit from the stimulation with regard to their cluster headaches despite an adequate spread of the stimulation over the occiput. Field width of the stimulation was not correlated with reduction of cluster attacks, intensity of attacks or response to treatment at all.

Conclusions: From our study, we conclude that a reproducible stimulation of the GON can be achieved by placing the electrodes parallel to the atlas, in about 30 mm distance to the external occipital protuberance. The response to the stimulation is not correlated to the field width of the paraesthesia. We, therefore, consider the stimulation of the main trunk of the GON to be more important than a large field of stimulation on the occiput. Still, an individual response to the therapy cannot be predicted even by optimal electrode placement.