Q: Dr. Eppley, I am interested in occipital knob reduction surgery. I have an occipital knob I would like removed on the back of my head. My initial questions are:
1) would I need to arrange a scan or something similar over here to send to you or would you be able to see enough from pictures I can provide to determine whether I am a suitable candidate for this surgery?
2) is this surgery only performed under general anaesthesia, could it be performed under twilight or local even?
3) what are the potential risks of the surgery?
A: No x-ray or preoperative visit is needed for the occipital knob reduction procedure. Pictures alone are all the preoperative information that I need which you can send to me at any time. The surgery is done in the prone position (face down) and the occipital region is virtually impossible to adequately make numb by local anesthetic to adequately perform the procedure. IV sedation can not be performed in the prone position due to inadequate protection of the airway. Thus general anesthesia must be used for the occipital knob reduction procedure. The only minor risk, and an expected one, is the small horizontal scalp incision/scar used to perform the procedure.
Dr. Barry Eppley
Q: Dr. Eppley, I’ve had this large bump on the back of my head y for as long as I can remember. I think they call it an occipital knob. I would like it removed. I have many questions about the procedure. Here they are
1. How do I get an appointment with you?
2. Is there a hospital stay for this surgery or is it same day surgery?
3. Have you found that insurance willpay for the operation?
4. Is this skull deformity a common problem?
5. How soon would an operation be scheduled?
I’m very excited about finding a doctor who can help me feel better and not have any more headaches.
A: In answer to your occipital knob reduction questions:
1) We can talk by phone or Skype as soon as you would like
2) This is an outpatient procedure that takes one hour to complete under general anesthesia.
3) This would not be an insurance covered procedure to my knowledge.
4) I can not speak for exactly how common it is but I suspect it occurs in about 1:1000 people.
5) Since it is a relatively short operation, it can be scheduled fairly quickly.
You made an interesting statement about relief of headaches. I am not aware that an occipital knob reduction does relieve headaches although I can see how that might occur. There are tight muscle and fascial attachments at the base of the occipital knob and release of these may provide relief of some occipital-based headaches.
Dr. Barry Eppley
Q: Dr. Eppley, I have an occipital knob on the back of my head just like the one you have shown in your website. It’s destroying my self confidence and I would like it removed. How is it done, what is the recovery like and how much would a procedure like this cost?
A: The occipital knob is a prominent bulge of bone at the back of the head on the lower edge of the occipital bone along the nuchal line in the midline. It is an abnormal thickening of completely cortical bone that sticks out like a knob. It is most commonly a concern for men who shave their head or have very short hair. I have seen some really impressive occipital knobs that are extremely prominent. Surgical reduction/flattening of this bone knob is done through a small horizontal incision over it, usually no greater than 3 to 3.5 cms in length. (limited incision occipital reduction cranioplasty) The knob is burred down to be smooth with the surrounding bone. Usually I will then suture the soft tissues down to the bone surface through bone holes to make sure no fluid develops between the skin and the reduced bone. The skin is then closed with small dissolveable sutures. This procedure takes about one hour under general anesthesia and is done as an outpatient procedure. The cost of the procedure, all expenses included, is usually around $ 4,000 to $4,500.
Dr. Barry Eppley