A Case Report of an Enlarged Suboccipital Nerve with Cutaneous Branch.

Cureus. 2018 Jul 6;10(7):e2933. doi: 10.7759/cureus.2933.

Lake S, Iwanaga J, Oskouian RJ, Loukas M, Tubbs RS.

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Abstract

Variations of the suboccipital nerve are infrequently reported. This nerve derived from the C1 spinal nerve is usually a small branch that primarily innervates the short suboccipital muscles. During the routine dissection of the occipital region in an adult cadaver, a vastly enlarged left-sided suboccipital nerve was identified. The nerve innervated the short suboccipital muscles and overlying semispinalis capitis in normal fashion. However, it continued cranially to end in the overlying skin of the occiput. Although not normally thought to have a cutaneous branch, recalcitrant occipital neuralgia might be due to such a variant branch. Future studies are necessary to further elucidate this proposed pathomechanism.

KEYWORDS:

c1 nerve; occiput cutaneous innervation; sensory suboccipital nerve; suboccipital nerve

Figure 1

Schematic drawing of the specimen reported herein.

Note the variant cutaneous branch of the suboccipital nerve on the left side.

Figure 2

Cadaveric specimen with dissection of the suboccipital region.

Note the large and long dorsal ramus of C1 on the left and compare this to the size of the normal dorsal ramus of C1 on the right side. For reference, the semispinalis capitis muscle is reflected laterally on both sides. Also observe the relationship of the suboccipital nerves and the vertebral arteries as they course over the posterior arch of the atlas.