Surgeons investigated the potential of utilizing small intestinal submucosa (SIS) nerve caps after greater or lesser occipital nerve decompression to mitigate pain in certain headache cases.
The group described two patients treated by nerve capping.1
Occipital neuralgia, a subset of undifferentiated facial pain, does not always respond to medical treatments. In those cases, decompression of the affected nerves is the gold standard for treating headaches.
If primary decompression fails, then secondary transection of the nerve is considered.
The authors previously described using regenerative peripheral nerve interfaces (RPNIs), targeted muscle reinnervation (TMR), and neurectomy with relocation nerve grafting to address the proximal nerve stump.2 However, they realized that in certain cases, they need additional options.
They described the utilization of a nerve cap derived from SIS to minimize headache pain.
In the first case described,1 the patient had undergone right greater occipital nerve (GON) decompression four years prior but continued to experience constant daily pain. Three months after implantation of the SIS nerve cap, the patient had significant subjective improvements in baseline pain. One year after implantation, the patient reported a 40–50% improvement compared to before surgery, with constant pain reduced to four hours, on average.
In the second case described,1 the patient had bilateral GON decompression nine months prior to SIS nerve cap implantation on the right GON. At four months post implantation, the patient reported a complete resolution of pain on the right side, which continued to the one-year follow-up.
Clinical cases are unique and individual results may vary. The authors concluded that though larger patient cohorts with longer follow-ups are necessary, nerve capping is another method available to address the proximal nerve stump.
1Hwang CD, Chegireddy V, Remy K, et al. The use of nerve caps after nerve transection in headache surgery: cadaver and case reports. Plast Reconstr Surg Glob Open. 2023;11(9):e5234.
2Gfrerer L, Wong FK, Hickle K, Eberlin KR, Valerio IL, Austen WG, et al. RPNI, TMR and reset neurectomy/relocation nerve grafting after nerve transection in headache surgery. Plast Reconstr Surg Glob Open. 2022;10(3):e4201.