Aesthetic Outcomes of Transverse vs. Longitudinal Incision Techniques in Occipital Nerve Decompression Surgery

SDCC 

Introduction: Surgical treatment of occipital headaches involves the decompression of peripheral occipital nerves. While the literature extensively describes the longitudinal midline incision approach, our group employs the transverse approach. (1-4) The aesthetic outcomes of both incision techniques remain unexplored.

Methods: Patients undergoing surgical decompression for occipital headaches were instructed to provide images of their exposed occipital scalp scar. Evaluation was conducted using the Stony Brook Scar Evaluation Scale (SBSES) and the Scar Cosmesis Assessment and Rating (SCAR) scale by three independent plastic surgeons. SBSES scores range from 0-5 (higher indicating better outcomes), while SCAR scores range from 0-15 (higher indicating worse outcomes). Comparisons were made between transverse and longitudinal scars, with factors influencing scores identified.

Results: Forty patients (average age: 47; 73% female) participated, with 28% having longitudinal midline scars and 72% having transverse scars. Patients with transverse scars exhibited higher SBSES scores (4.2 vs. 3.6; p=0.044) and lower SCAR scores (3.0 vs. 4.6; p=0.016). Longitudinal scar patients displayed more suture marks (SBSES: p=0.018; SCAR p= 0.003) and wider scar spread (SBSES: p= 0.013; SCAR: p= 0.038) compared to transverse scar patients. On regression analysis, higher BMI was associated with worse SCAR scores (p=0.015) and nearing significance in SBSES scores (p=0.057).


Conclusion: Our study reveals superior aesthetic outcomes with the transverse incision approach for occipital nerve decompression surgery compared to the longitudinal midline technique. Transverse scars exhibited higher SBSES scores and lower SCAR scores, indicating better cosmesis. Notably, longitudinal scars were associated with more prominent suture marks and wider scar spread.


1.Gfrerer, L., W.G. Austen, Jr., and J.E. Janis, Migraine Surgery. Plast Reconstr Surg Glob Open, 2019. 7(7): p. e2291.
2.Lee, M., et al., The role of the third occipital nerve in surgical treatment of occipital migraine headaches. J Plast Reconstr Aesthet Surg, 2013. 66(10): p. 1335-9.
3. Ducic, I., E.C. Hartmann, and E.E. Larson, Indications and outcomes for surgical treatment of patients with chronic migraine headaches caused by occipital neuralgia. Plast Reconstr Surg, 2009. 123(5): p. 1453-1461.
4. Afifi, A.M., et al., Alternative Approach for Occipital Headache Surgery: The Use of a Transverse Incision and "W" Flaps. Plast Reconstr Surg Glob Open, 2019. 7(4): p. e2176.

Migraine and Peripheral Nerve

PSTM 2024