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Great Occipital Nerve as a Motor Donor Nerve in Brachial Plexus Palsy

Objective: The main purpose of this study is to evaluate the great occipital nerve (GON) as a possible donor nerve in brachial plexus reconstruction. The secondary objectives are to describe the path, the relations, and peripheral nerve length and its mobilization to reach the suprascapular nerve. Materials and Methods: Eight cadaveric specimens were used with dissections of the 2 GONs with a total of 16 GONs. They were dissected from the outlet at the rachis up to its surface emergence. Length measurements were registered between these points; the topographic point of its emergence in the nape skin was identified. Also the mobilization from this point to the inner scapula angle was recorded. Finally, the number of axons before and after the exit of the motor branches for the nape muscles was histologically studied. Results: Six and 2 of 8 specimens were males and females, respectively. The length from its exit between the first and second cervical vertebrae and its emergence in the nape skin was 62 mm average. With lateral nerve mobilization, a distance of 27 mm to the medial border and superior angle of the scapula was reached. Also, the length to the suprascapular notch was measured obtaining an average distance of 73 mm. Conclusions: The amount of motor nerve donors to transfer in preganglionic brachial plexus palsy is very low and the GON can be a new option. Using the mobilization, the GON can be reached close to the suprascapular notch. This is an alternative to neurotize the suprascapular nerve without graft and to free the accessory nerve for another transfer. Although the sample is very low, we believe the GON can be a new source of nerve donor motor for brachial plexus reconstruction.