Decompression of the Greater Occipital Nerve for Occipital Neuralgia and Chronic Occipital Headache Caused by Entrapment of the Greater Occipital Nerve

2022 ◽  
Author(s):  
Byung-chul Son
Keyword(s):  
Pain Relief ◽  
Rating Scale ◽  
Likert Scale ◽  
Pain Intensity Score ◽  
Occipital Neuralgia ◽  
Subjective Improvement ◽  
Occipital Nerve ◽  
Greater Occipital Nerve ◽  
Occipital Headache

Abstract Background Chronic entrapment of the greater occipital nerve (GON) can not only manifest in typical stabbing pain of occipital neuralgia (ON) but also lead to continuous ache and pressure-like pain in the occipital and temporal areas. However, the effect of GON decompression on these symptoms has yet to be established. We report the follow-up results of GON decompression in typical cases of ON and chronic occipital headache due to GON entrapment (COHGONE). Methods A 1-year follow-up study of GON decompression was conducted on 11 patients with typical ON and 39 COHGONE patients with GON entrapment. The degree of pain reduction was analyzed using the numerical rating scale-11 (NRS-11) score and percent pain relief before and 1 year after surgery. A success was defined by at least a 50% reduction in pain measured via NRS-11 during the 12-month follow-up. To assess the degree of subjective satisfaction, a 10-point Likert scale was used. Postoperative outcome was also evaluated using the Barrow Neurological Institute (BNI) pain intensity score. The difference in GON decompression between the patients with typical ON and those with COHGONE was studied. Results GON decompression was successful in 43 of 50 patients (86.0%) and percent pain relief was 72.99 ± 25.53. Subjective improvement based on a 10-point Likert scale was 7.9 ± 2.42 and the BNI grade was 2.06 ± 1.04. It was effective in both the ON and COHGONE groups, but the success rate was higher in the ON group (90.9%) than in the COHGONE group (84.6%), showing statistically significant differences in the results based on average NRS-11 score, percent pain relief, subjective improvement, and BNI grades (p < 0.05, independent t-test). Conclusion GON decompression is effective in chronic occipital headache and in ON symptoms induced by GON entrapment.

scholarly journals Effectiveness of treatment of occipital neuralgia using the nerve block technique: a prospective analysis of 44 patients

2018 ◽  
Vol 25 (2) ◽  
pp. 53-60 ◽  
Author(s):  
Raimondas Juškys ◽  
Gytis Šustickas
Keyword(s):  
Nerve Block ◽  
Local Anaesthetic ◽  
Pain Intensity Score ◽  
Occipital Neuralgia ◽  
Management Options ◽  
Occipital Nerve ◽  
Significant Difference ◽  
Vas Scores ◽  
Occipital Nerve Block

Background. There is a great deal of tools for treatment of occipital neuralgia but currently we are lacking a complete consensus among practitioners regarding the optimal approach to this debilitating condition. Occipital nerve block (ONB) is known as one of the management options but there is lack of scientific literature exploring its effectiveness. Materials and methods. The prospective study was undertaken between March 2014 and February 2018 at the State Vilnius University Hospital. Fortyfour patients aged from 28 to 84 years (age mean = 56.30 ± 14.71) of which 79.55% were female (n = 35) were diagnosed with occipital neuralgia (ON) and treated with a local anaesthetic and corticosteroids combination injection into the greater or greater plus lesser occipital nerve (n = 29 and n = 15, respectively) and followed up after 6 months. Analysis of the outcomes of those patients was done by comparing the Visual Analog Scale (VAS) and Barrow Neurological Institute Pain Intensity Score (BNIPIS) prior to treatment, 24 hours after the block, and at a follow-up 6 months later. Analgesic medication consumption before and after 6 months was recorded. A comparison of procedure efficacy in lidocaine and bupivacaine groups was made. Evaluation of block potency for acute and chronic pain categories was conducted as well. The success criteria were defined as patient satisfaction with own condition for at least 6 months, not requiring another block in order to stay comfortable. Results. Of 44 patients, 42 (95.45%) who underwent the occipital nerve block procedure showed satisfactory results for at least 6 months. Mean headache VAS scores decreased from 7.23 ± 0.93 (pre-treatment) to 1.95 ± 1.59 (24 hours after, p < 0.0001) and increased to 2.21 ± 1.73 at the follow-up after 6 months, showing no statistically significant difference between post-interventional and six-month VAS scores (p = 0.07). In all patients the necessity of medication to control pain decreased to 16.67% (n = 7) during the the check-up after 6 months. There was no statistically significant difference in the effectiveness of ONB with regard to the local anaesthetic used or the pain group targeted. Similar results were obtained comparing patients who underwent more than one ONB. Conclusions. Occipital nerve block with a local anaesthetic and corticosteroids provides a safe, simple, and effective treatment method for the patient with medically-refractory occipital neuralgia.

scholarly journals Could a Simple Nerve Block be Considered as a Treatment Option for Occipital Neuralgia with Both Short-Term and Long-Term Effects?

The Nerve ◽  
2021 ◽  
Vol 7 (2) ◽  
pp. 31-35
Author(s):  
Jeong-Woo Kwun ◽  
Young Jin Kim ◽  
Jin-Shup So
Keyword(s):  
Nerve Block ◽  
Traumatic Event ◽  
Occipital Neuralgia ◽  
Short Term ◽  
Occipital Nerve ◽  
Long Term Treatment ◽  
Greater Occipital Nerve ◽  
Short And Long Term

Objective: The study aims to show both the short- and long-term treatment outcome of occipital nerve block (ONB) patients with occipital neuralgia (ON).Methods: Patients who visited our hospital between 2013 and 2020 were reviewed retrospectively. Patients were excluded if the medical records were incomplete, if they had received a cervical operation, if they had a traumatic event prior to the symptom onset, or if the follow-up period was less than 3 months. ONB targeted the greater occipital nerve, the lesser occipital nerve or both. Short term follow-up period was defined as 3 months and long term was defined as 12 months. Injection consisted of a mixture of triamcinolone acetonide, lidocaine, and normal saline. Visual analogue scale (VAS) was recorded and compared before and during the follow-up to period to assess treatment outcome.Results: Clinical charts of 309 candidates were reviewed and 72 patients were excluded, making it 237 patients. VAS scores significantly decreased in both 3-month follow-up (from 7.20±0.94 to 3.48 ±1.66, p<0.05) and after 1 year follow-up (from 7.20±0.94 to 2.71±1.07, p<0.05). Only 8 patients (3.3%) were refractory to ONB and the procedure was found to be relatively safe since only 2 patients (0.8%) showed transient side effects.Conclusion: There are many treatment options for ON. However, from the results of our study, conservative treatment via ONB may have sufficient effect in controlling symptoms of ON in both short and long term.

Greater Occipital Nerve Decompression for Occipital Neuralgia

2018 ◽  
Vol 29 (5) ◽  
pp. e518-e521 ◽  
Author(s):  
Anson Jose ◽  
Shakil Ahmed Nagori ◽  
Probodh K. Chattopadhyay ◽  
Ajoy Roychoudhury
Keyword(s):  
Occipital Neuralgia ◽  
Occipital Nerve ◽  
Nerve Decompression ◽  
Greater Occipital Nerve

scholarly journals CT-guided infiltration of greater occipital nerve for refractory craniofacial pain syndromes other than occipital neuralgia

2020 ◽  
Vol 101 (10) ◽  
pp. 643-648
Author(s):  
A. Ricquart Wandaele ◽  
A. Kastler ◽  
A. Comte ◽  
G. Hadjidekov ◽  
R. Kechidi ◽  
...  
Keyword(s):  
Occipital Neuralgia ◽  
Ct Guided ◽  
Occipital Nerve ◽  
Pain Syndromes ◽  
Greater Occipital Nerve ◽  
Craniofacial Pain

Treatment of occipital neuralgia by partial posterior rhizotomy at C1–3

1995 ◽  
Vol 82 (4) ◽  
pp. 581-586 ◽  
Author(s):  
David Dubuisson
Keyword(s):  
Sensory Loss ◽  
Minimal Risk ◽  
Occipital Neuralgia ◽  
Content Type ◽  
Occipital Nerve ◽  
Root Entry Zone ◽  
Relieve Pain ◽  
Greater Occipital Nerve ◽  
Upper Cervical ◽  
Postoperative Vertigo

✓ To minimize the sensory loss associated with intradural posterior rhizotomy for medically refractory occipital neuralgia, partial sectioning of the upper cervical posterior rootlets was performed in 11 patients. The ventrolateral aspect of each posterior rootlet from C-1 to the upper portion of C-3 was divided at the root entry zone. In three patients with bilateral neuralgia, the procedure was performed on both sides, for a total of 14 partial rhizotomy procedures in the 11 patients. This resulted in satisfactory preservation of scalp sensation in all cases. Pain within the territory of the greater occipital nerve was consistently reduced or abolished by this procedure. The overall degree of pain relief was rated good or excellent after 10 of the 14 procedures. The other four procedures alleviated pain in the territory of the greater occipital nerve, but the results were marred by persistent periorbital or temporal pain. Two patients subsequently underwent complete C1–3 posterior rhizotomy without further improvement. Although partial posterior rhizotomy at C1–3 did not always relieve pain in the periorbital and temporal regions, this procedure did provide consistent long-term relief of severe occipital pain with minimal risk of postoperative vertigo, scalp anesthesia, or deafferentation syndrome.

Gamma Knife radiosurgery for trigeminal neuralgia: the impact of magnetic resonance imaging–detected vascular impingement of the affected nerve

2010 ◽  
Vol 113 (1) ◽  
pp. 53-58 ◽  
Author(s):  
Jason P. Sheehan ◽  
Dibyendu Kumar Ray ◽  
Stephen Monteith ◽  
Chun Po Yen ◽  
James Lesnick ◽  
...  
Keyword(s):  
Pain Relief ◽  
Mr Imaging ◽  
Trigeminal Neuralgia ◽  
Gamma Knife ◽  
Trigeminal Nerve ◽  
Gamma Knife Radiosurgery ◽  
Vascular Compression ◽  
Pain Intensity Score ◽  
The Impact

Object Trigeminal neuralgia is believed to be related to vascular compression of the affected nerve. Radiosurgery has been shown to be reasonably effective for treatment of medically refractory trigeminal neuralgia. This study explores the rate of occurrence of MR imaging–demonstrated vascular impingement of the affected nerve and the extent to which vascular impingement affects pain relief in a population of trigeminal neuralgia patients undergoing Gamma Knife radiosurgery (GKRS). Methods The authors performed a retrospective analysis of 106 cases involving patients treated for typical trigeminal neuralgia using GKRS. Patients with or without single-vessel impingement on CISS MR imaging sequences and with no previous surgery were included in the study. Pain relief was assessed according to the Barrow Neurological Institute (BNI) pain intensity score at the last follow-up. Degree of impingement, nerve diameter preand post-impingement, isocenter placement, and dose to the point of maximum impingement were evaluated in relation to the improvement of BNI score. Results The overall median follow-up period was 31 months. Overall, a BNI pain score of 1 was achieved in 59.4% of patients at last follow-up. Vessel impingement was seen in 63 patients (59%). There was no significant difference in pain relief between those with and without vascular impingement following GKRS (p > 0.05). In those with vascular impingement on MR imaging, the median fraction of vessel impingement was 0.3 (range 0.04–0.59). The median dose to the site of maximum impingement was 42 Gy (range 2.9–79 Gy). Increased dose (p = 0.019) and closer proximity of the isocenter to the site of maximum vessel impingement (p = 0.012) correlated in a statistically significant fashion with improved BNI scores in those demonstrating vascular impingement on the GKRS planning MR imaging Conclusions Vascular impingement of the affected nerve was seen in the majority of patients with trigeminal neuralgia. Overall pain relief following GKRS was comparable in those with and without evidence of vascular compression on MR imaging. In subgroup analysis of those with MR imaging evidence of vessel impingement of the affected trigeminal nerve, pain relief correlated with a higher dose to the point of contact between the impinging vessel and the trigeminal nerve. Such a finding may point to vascular changes affording at least some degree of relief following GKRS for trigeminal neuralgia.

Earlier radiosurgery leads to better pain relief and less medication usage for trigeminal neuralgia patients: an international multicenter study

2020 ◽  
pp. 1-8
Author(s):  
Monica Mureb ◽  
Danielle Golub ◽  
Carolina Benjamin ◽  
Jason Gurewitz ◽  
Ben A. Strickland ◽  
...  
Keyword(s):  
Pain Relief ◽  
Radiation Dose ◽  
Trigeminal Neuralgia ◽  
Latency Period ◽  
Type I ◽  
Pain Intensity Score ◽  
Pain Outcomes ◽  
The Mean ◽  
International Multicenter Study

OBJECTIVETrigeminal neuralgia (TN) is a chronic pain condition that is difficult to control with conservative management. Furthermore, disabling medication-related side effects are common. This study examined how stereotactic radiosurgery (SRS) affects pain outcomes and medication dependence based on the latency period between diagnosis and radiosurgery.METHODSThe authors conducted a retrospective analysis of patients with type I TN at 12 Gamma Knife treatment centers. SRS was the primary surgical intervention in all patients. Patient demographics, disease characteristics, treatment plans, medication histories, and outcomes were reviewed.RESULTSOverall, 404 patients were included. The mean patient age at SRS was 70 years, and 60% of the population was female. The most common indication for SRS was pain refractory to medications (81%). The median maximum radiation dose was 80 Gy (range 50–95 Gy), and the mean follow-up duration was 32 months. The mean number of medications between baseline (pre-SRS) and the last follow-up decreased from 1.98 to 0.90 (p < 0.0001), respectively, and this significant reduction was observed across all medication categories. Patients who received SRS within 4 years of their initial diagnosis achieved significantly faster pain relief than those who underwent treatment after 4 years (median 21 vs 30 days, p = 0.041). The 90-day pain relief rate for those who received SRS ≤ 4 years after their diagnosis was 83.8% compared with 73.7% in patients who received SRS > 4 years after their diagnosis. The maximum radiation dose was the strongest predictor of a durable pain response (OR 1.091, p = 0.003). Early intervention (OR 1.785, p = 0.007) and higher maximum radiation dose (OR 1.150, p < 0.0001) were also significant predictors of being pain free (a Barrow Neurological Institute pain intensity score of I–IIIA) at the last follow-up visit. New sensory symptoms of any kind were seen in 98 patients (24.3%) after SRS. Higher maximum radiation dose trended toward predicting new sensory deficits but was nonsignificant (p = 0.075).CONCLUSIONSTN patients managed with SRS within 4 years of diagnosis experienced a shorter interval to pain relief with low risk. SRS also yielded significant decreases in adjunct medication utilization. Radiosurgery should be considered earlier in the course of treatment for TN.

Greater Occipital Nerve Excision for Occipital Neuralgia Refractory to Nerve Decompression

2014 ◽  
Vol 72 (2) ◽  
pp. 184-187 ◽  
Author(s):  
Ivica Ducic ◽  
John M. Felder ◽  
Neelam Khan ◽  
Sojin Youn
Keyword(s):  
Occipital Neuralgia ◽  
Occipital Nerve ◽  
Nerve Decompression ◽  
Greater Occipital Nerve
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