Cruveilhier plexus: An anatomical study and a potential cause of failed treatments for occipital neuralgia and muscular and facet denervation procedures: Laboratory investigation

R. Shane Tubbs, Martin M. Mortazavi, Marios Loukas, Anthony V. D'Antoni, Mohammadali Mohajel Shoja, Aaron A. Cohen-Gadol

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Object. The nerves of the posterior neck are often encountered by the neurosurgeon and are sometimes the focus of denervation procedures for muscular, joint, or nervous pathologies. One collection of fibers in this region that has not been previously investigated is the Cruveilhier plexus, interneural connections between the dorsal rami of the upper cervical nerves. Methods. Fifteen adult cadavers (30 sides) were subjected to dissection of the upper cervical and occipital regions with special attention given to identifying potential connections between adjacent extradural dorsal rami of the cervical nerves. When connections were identified, measurements were made and random samples were immunohistochemically stained. Results. At least one communicating branch was identified on 86.7% of sides. Sampled nervous loops were composed primarily of sensory fibers, but occasional motor fibers were identified. For C-1, a communicating loop joined the medial branches of C-2 on 65.4% of sides. On 29.4% of sides, this loop pierced the obliquus capitis inferior muscle before joining C-2. On 54% of sides, a communicating loop joined the medial branches of the dorsal rami of C-2 and C-3; and on 15.4% of sides, a communicating loop joined the medial branches of the dorsal rami of C-3 and C-4. No specimen had communicating branches between the dorsal rami of cervical nerves C-5 to C-8. Articular branches arose from the deep surface of the interneural connections as they crossed the adjacent facet joint on 34.6% of sides. Loops giving rise to fibers that terminated into surrounding musculature were seen on 35% of sides. Conclusions. Physical examinations that reveal unexpected results, such as altered sensory dermatome findings, may be attributed to the Cruveilhier plexus. Based on findings in the present study, surgical procedures, such as those aimed at completely denervating the upper posterior cervical musculature, facets, or nerves supplying the skin of the occiput, must also transect the Cruveilhier plexus.

Original languageEnglish (US)
Pages (from-to)929-933
Number of pages5
JournalJournal of Neurosurgery
Volume115
Issue number5
DOIs
StatePublished - Nov 1 2011
Externally publishedYes

Fingerprint

Neuralgia
Denervation
Joints
Zygapophyseal Joint
Occipital Lobe
Cadaver
Physical Examination
Dissection
Neck
Therapeutics
Pathology
Muscles
Skin

Keywords

  • Cruveilhier plexus
  • Neck
  • Nerve connection
  • Neuralgia
  • Occiput
  • Pain

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Cruveilhier plexus : An anatomical study and a potential cause of failed treatments for occipital neuralgia and muscular and facet denervation procedures: Laboratory investigation. / Tubbs, R. Shane; Mortazavi, Martin M.; Loukas, Marios; D'Antoni, Anthony V.; Mohajel Shoja, Mohammadali; Cohen-Gadol, Aaron A.

In: Journal of Neurosurgery, Vol. 115, No. 5, 01.11.2011, p. 929-933.

Research output: Contribution to journalArticle

Tubbs, R. Shane ; Mortazavi, Martin M. ; Loukas, Marios ; D'Antoni, Anthony V. ; Mohajel Shoja, Mohammadali ; Cohen-Gadol, Aaron A. / Cruveilhier plexus : An anatomical study and a potential cause of failed treatments for occipital neuralgia and muscular and facet denervation procedures: Laboratory investigation. In: Journal of Neurosurgery. 2011 ; Vol. 115, No. 5. pp. 929-933.
@article{725be1cc19b14bb0a21ef1fb8270162e,
title = "Cruveilhier plexus: An anatomical study and a potential cause of failed treatments for occipital neuralgia and muscular and facet denervation procedures: Laboratory investigation",
abstract = "Object. The nerves of the posterior neck are often encountered by the neurosurgeon and are sometimes the focus of denervation procedures for muscular, joint, or nervous pathologies. One collection of fibers in this region that has not been previously investigated is the Cruveilhier plexus, interneural connections between the dorsal rami of the upper cervical nerves. Methods. Fifteen adult cadavers (30 sides) were subjected to dissection of the upper cervical and occipital regions with special attention given to identifying potential connections between adjacent extradural dorsal rami of the cervical nerves. When connections were identified, measurements were made and random samples were immunohistochemically stained. Results. At least one communicating branch was identified on 86.7{\%} of sides. Sampled nervous loops were composed primarily of sensory fibers, but occasional motor fibers were identified. For C-1, a communicating loop joined the medial branches of C-2 on 65.4{\%} of sides. On 29.4{\%} of sides, this loop pierced the obliquus capitis inferior muscle before joining C-2. On 54{\%} of sides, a communicating loop joined the medial branches of the dorsal rami of C-2 and C-3; and on 15.4{\%} of sides, a communicating loop joined the medial branches of the dorsal rami of C-3 and C-4. No specimen had communicating branches between the dorsal rami of cervical nerves C-5 to C-8. Articular branches arose from the deep surface of the interneural connections as they crossed the adjacent facet joint on 34.6{\%} of sides. Loops giving rise to fibers that terminated into surrounding musculature were seen on 35{\%} of sides. Conclusions. Physical examinations that reveal unexpected results, such as altered sensory dermatome findings, may be attributed to the Cruveilhier plexus. Based on findings in the present study, surgical procedures, such as those aimed at completely denervating the upper posterior cervical musculature, facets, or nerves supplying the skin of the occiput, must also transect the Cruveilhier plexus.",
keywords = "Cruveilhier plexus, Neck, Nerve connection, Neuralgia, Occiput, Pain",
author = "Tubbs, {R. Shane} and Mortazavi, {Martin M.} and Marios Loukas and D'Antoni, {Anthony V.} and {Mohajel Shoja}, Mohammadali and Cohen-Gadol, {Aaron A.}",
year = "2011",
month = "11",
day = "1",
doi = "10.3171/2011.5.JNS102058",
language = "English (US)",
volume = "115",
pages = "929--933",
journal = "Journal of Neurosurgery",
issn = "0022-3085",
publisher = "American Association of Neurological Surgeons",
number = "5",

}

TY - JOUR

T1 - Cruveilhier plexus

T2 - An anatomical study and a potential cause of failed treatments for occipital neuralgia and muscular and facet denervation procedures: Laboratory investigation

AU - Tubbs, R. Shane

AU - Mortazavi, Martin M.

AU - Loukas, Marios

AU - D'Antoni, Anthony V.

AU - Mohajel Shoja, Mohammadali

AU - Cohen-Gadol, Aaron A.

PY - 2011/11/1

Y1 - 2011/11/1

N2 - Object. The nerves of the posterior neck are often encountered by the neurosurgeon and are sometimes the focus of denervation procedures for muscular, joint, or nervous pathologies. One collection of fibers in this region that has not been previously investigated is the Cruveilhier plexus, interneural connections between the dorsal rami of the upper cervical nerves. Methods. Fifteen adult cadavers (30 sides) were subjected to dissection of the upper cervical and occipital regions with special attention given to identifying potential connections between adjacent extradural dorsal rami of the cervical nerves. When connections were identified, measurements were made and random samples were immunohistochemically stained. Results. At least one communicating branch was identified on 86.7% of sides. Sampled nervous loops were composed primarily of sensory fibers, but occasional motor fibers were identified. For C-1, a communicating loop joined the medial branches of C-2 on 65.4% of sides. On 29.4% of sides, this loop pierced the obliquus capitis inferior muscle before joining C-2. On 54% of sides, a communicating loop joined the medial branches of the dorsal rami of C-2 and C-3; and on 15.4% of sides, a communicating loop joined the medial branches of the dorsal rami of C-3 and C-4. No specimen had communicating branches between the dorsal rami of cervical nerves C-5 to C-8. Articular branches arose from the deep surface of the interneural connections as they crossed the adjacent facet joint on 34.6% of sides. Loops giving rise to fibers that terminated into surrounding musculature were seen on 35% of sides. Conclusions. Physical examinations that reveal unexpected results, such as altered sensory dermatome findings, may be attributed to the Cruveilhier plexus. Based on findings in the present study, surgical procedures, such as those aimed at completely denervating the upper posterior cervical musculature, facets, or nerves supplying the skin of the occiput, must also transect the Cruveilhier plexus.

AB - Object. The nerves of the posterior neck are often encountered by the neurosurgeon and are sometimes the focus of denervation procedures for muscular, joint, or nervous pathologies. One collection of fibers in this region that has not been previously investigated is the Cruveilhier plexus, interneural connections between the dorsal rami of the upper cervical nerves. Methods. Fifteen adult cadavers (30 sides) were subjected to dissection of the upper cervical and occipital regions with special attention given to identifying potential connections between adjacent extradural dorsal rami of the cervical nerves. When connections were identified, measurements were made and random samples were immunohistochemically stained. Results. At least one communicating branch was identified on 86.7% of sides. Sampled nervous loops were composed primarily of sensory fibers, but occasional motor fibers were identified. For C-1, a communicating loop joined the medial branches of C-2 on 65.4% of sides. On 29.4% of sides, this loop pierced the obliquus capitis inferior muscle before joining C-2. On 54% of sides, a communicating loop joined the medial branches of the dorsal rami of C-2 and C-3; and on 15.4% of sides, a communicating loop joined the medial branches of the dorsal rami of C-3 and C-4. No specimen had communicating branches between the dorsal rami of cervical nerves C-5 to C-8. Articular branches arose from the deep surface of the interneural connections as they crossed the adjacent facet joint on 34.6% of sides. Loops giving rise to fibers that terminated into surrounding musculature were seen on 35% of sides. Conclusions. Physical examinations that reveal unexpected results, such as altered sensory dermatome findings, may be attributed to the Cruveilhier plexus. Based on findings in the present study, surgical procedures, such as those aimed at completely denervating the upper posterior cervical musculature, facets, or nerves supplying the skin of the occiput, must also transect the Cruveilhier plexus.

KW - Cruveilhier plexus

KW - Neck

KW - Nerve connection

KW - Neuralgia

KW - Occiput

KW - Pain

UR - http://www.scopus.com/inward/record.url?scp=80655145862&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=80655145862&partnerID=8YFLogxK

U2 - 10.3171/2011.5.JNS102058

DO - 10.3171/2011.5.JNS102058

M3 - Article

C2 - 21682566

AN - SCOPUS:80655145862

VL - 115

SP - 929

EP - 933

JO - Journal of Neurosurgery

JF - Journal of Neurosurgery

SN - 0022-3085

IS - 5

ER -