Evaluating the Evidence: Is Neurolysis or Neurectomy a Better Treatment for Occipital Neuralgia?

Background: Occipital neuralgia associated with migraine or cervicogenic headache is not uncommon clinical syndrome. It's still a debatable issue regarding the pathogenesis and treatment options in the literature. Objective: It was to study and analyze the rule of microsurgical decompression of C2 nerve and it's ganglion in management of intractable occipital neuralgia with migraine. Patients and Methods: Thirty-six patients with this syndrome had been subjected to full clinical assessment to fulfill the clinical criteria of having occipital neuralgia with migraine (cervicogenic headache). All patients were subjected to image guided C2 ganglion anesthetic block and corticosteroid administration as a therapeutic test. Results: Among the 10 patients who had surgery and during a mean full up period of 28.1 months, 6 patients 60% (7 sides) were totally free of pain. Three patients (30%) showed moderate degree of improvement with less frequent attacks and controlled with minor medication. Only one patient (10%) showed no improvement but still without worsening of his preoperative symptoms. In nine patients (90%) the main pathology was vascular compression by vertebral venous plexus around the root and ganglion, while in six (60%) patients we found the hypertrophied dorsal atlanto-epistrophic ligament is the main pathology. Osteoarthritic sharp lower border of C1 vertebrae and lateral mass were found in three patients (30%). Conclusion: Good selection of patients with typical clinical presentation together with C2 ganglion anesthetic block were the key of success of microsurgical decompression of C2 nerve and ganglion as a valid treatment option in intractable occipital neuralgia with migraine.

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“…McNutt et al (27) in their systematic review found no evidence supporting neurolysis over neurectomy in management of cervicogenic headache.…”

Section: Surgical Treatment Of Occipital Neuralgia With Migraine (Cer...mentioning

confidence: 97%

Microsurgical Decompression of C2 Nerve and Ganglion as a Treatment Option for Occipital Neuralgia with Migraine

Eltantawy¹,

Arab²,

Elmeleigy³

2022

The Egyptian Journal of Hospital Medicine

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“…Three patients had complete elimination of pain, 6 patients had significant pain relief, and 2 patients did not improve [45]. A recent systematic review investigated 12 articles on surgical management of occipital neuralgia and did not find sufficient evidence to recommend neurolysis versus neurotomy [46…”

Section: Peripheral Nerve Stimulationmentioning

confidence: 99%

Occipital Neuralgia

Pan

Peng

Elmofty

2021

Curr Pain Headache Rep

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Purpose of Review Occipital neuralgia is a painful condition that affects the posterior aspect of the head and can be difficult to distinguish from other common forms of headaches. This article reviews the anatomy, pathophysiology, clinical presentation, differential diagnosis, diagnostic testing, and management approaches for occipital neuralgia. Recent Findings Non-pharmacological treatments aim to alleviate muscle tension and improve posture. Acupuncture shows some promise. The occipital nerve block is considered the first line in a minimally invasive intervention, but the duration of relief may be short term. An onabotulinum toxin A injection may improve the sharp but not the dull component of the pain of occipital neuralgia. Radiofrequency ablation and occipital nerve stimulation may provide effective long-term relief in refractory patients. Surgical decompression, neurotomies, and neurolysis are last-resort treatment options. Summary Occipital neuralgia is a debilitating condition that can be difficult to treat. Studies with larger sample sizes and randomized control trials are needed to further determine the effectiveness and safety of different therapies.

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“…On the contrary, the LON is considered a small sensory nerve with small innervation pattern, and transection is commonly performed during the initial surgery. 11 Although GON and LON transection has been discussed in a small number of publications, limited information on techniques to address the proximal nerve stump is available. 9 After transection of peripheral nerves, axons regenerate and grow in an unorganized fashion, resulting in formation of neuromas at the nerve stump.…”

Section: Introductionmentioning

confidence: 99%

RPNI, TMR, and Reset Neurectomy/Relocation Nerve Grafting after Nerve Transection in Headache Surgery

Gfrerer

Wong

Hickle

et al. 2022

Plastic and Reconstructive Surgery - Global Open

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Background: In the context of headache surgery, greater occipital nerve (GON) transection is performed when the nerve appears severely damaged, if symptoms are recurrent or persistent, and when neuromas are excised. Lesser occipital nerve (LON) excision is commonly performed during the primary decompression surgery. Advanced techniques to address the proximal nerve stump after nerve transection such as regenerative peripheral nerve interface (RPNI), targeted muscle reinnervation (TMR), relocation nerve grafting, and reset neurectomy have been shown to improve chronic pain and neuroma formation. These techniques have not been described in the head and neck region. Methods: This article describes RPNI, TMR, and reset neurectomy with GON autograft relocation to prevent chronic pain and neuroma formation after GON/LON transection. Results: RPNI and TMR are feasible options in patients undergoing GON/LON transection. Further, relocation nerve grafting with GON autograft relocation is a method that is beneficial in patients with diffuse nerve injury requiring proximal nerve division. Conclusion: Advanced nerve reconstruction techniques should be considered in headache surgery following GON/LON transection.

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Evaluating the Evidence: Is Neurolysis or Neurectomy a Better Treatment for Occipital Neuralgia?

Cited by 4 publications

References 13 publications

Microsurgical Decompression of C2 Nerve and Ganglion as a Treatment Option for Occipital Neuralgia with Migraine

Microsurgical Decompression of C2 Nerve and Ganglion as a Treatment Option for Occipital Neuralgia with Migraine

Occipital Neuralgia

RPNI, TMR, and Reset Neurectomy/Relocation Nerve Grafting after Nerve Transection in Headache Surgery

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