Summary
The surgical treatment of greater occipital neuralgia often involves diagnostic anesthetic blockade, followed by chemical or surgical ablation of the greater occipital nerve. The anatomy of this region was studied in microdissections of 2 cadaver specimens. The diagnosis and management of a series of 5 patients with greater occipital neuralgia is discussed. Two patients were treated with atlanto-epistrophic ligament decompression of the C 2 dorsal root ganglion and nerve; four patients had C 2 ganglionotomy performed. All patients in this series had immediate complete relief of pain following surgery. Patients were followed for a mean of 24 months (range 7–33 months). One patient had a recurrence of her original pain after 26 months following atlanto-epistrophic ligament decompression and required re-operation in the form of bilateral C 2 ganglionotomy. All patients experienced transient nausea and dizziness in the several days following surgery. One patient had an incisional cerebrospinal fluid leak.
Microsurgical C 2 gangliotomy is advocated as the preferred surgical treatment of greater occipital neuralgia of idiopathic origin.
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References
Bogduk N (1981) Local anesthetic blocks of the second cervical ganglion: a technique with application in occipital headache. Cephalalgia 1: 41–50
Bogduk N (1980) The anatomy of occipital neuralgia. Clin Exp Neurol 17: 167–184
Cox CL, Cocks GR (1979) Occipital neuralgia. J Med Assoc AL 48: 23–32
Ehni Q, Benner B (1984) Occipital neuralgia and the C 1–2 arthrosis syndrome. J Neurosurg 61: 961–965
Hammond SR, Danta G (1984) Occipital neuralgia. Clin Exp Neurol 15: 258–270
Hildebrandt J, Jansen J (1984) Vascular compression of the C2 and C3 roots — yet another cause of chronic intermittent hemicrania? Cephalalgia 4: 167–170
Hunter CR, Mayfield FH (1949) Role of upper cervical roots in the production of pain in the head. Am J Surg 48: 743–751
Jundt JW, Mock D (1991) Temporal arteritis with normal erythrocyte sedimentation rates presenting as occipital neuralgia. Arthr Rheumatism 34: 217–219
Poletti CE (1983) Proposed operation for occipital neuralgia: C-2 and C-3 root decompression. Neurosurgery 12: 221–224
Poletti CE, Sweet WH (1990) Entrapment of the C 2 root and ganglion by the atlanto-epistrophic ligament: clinical syndrome and surgical anatomy. Neurosurgery 27: 288–290
Smith DL, Lucas LM, Kumar KL (1987) Greater occipital neuralgia: an unusual presenting feature of neurosyphilis. Headache 27: 552–554
Stechison MT, Saint-Cyr JA (1986) Organization of spinal inputs to the perihypoglossal complex in the cat. J Comp Neurol 246: 555–567
Uematsu S (1988) Percutaneous electrothermal coagulation of spinal nerve trunk, ganglion, and rootlets. In: Schmidek HH et al (eds) Operative neurosurgical techniques, indications, methods, and results, 2nd Ed. Grune and Stratton, New York, pp1207–1221
White JC, Sweet WH (1969) Pain and the neurosurgeon. Thomas, Springfield
Wolff HG (1963) Headache and other pain, 2nd Ed. New York, pp 516–517 and 666–667
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Stechison, M.T., Mullin, B.B. Surgical treatment of greater occipital neuralgia: An appraisal of strategies. Acta neurochir 131, 236–240 (1994). https://doi.org/10.1007/BF01808620
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DOI: https://doi.org/10.1007/BF01808620