Schwannoma of the greater occipital nerve: An uncommon cause of occipital neuralgia

✓ 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.

Download Full-text

Greater Occipital Nerve Excision for Occipital Neuralgia Refractory to Nerve Decompression

Annals of Plastic Surgery ◽

10.1097/sap.0b013e3182898736 ◽

2014 ◽

Vol 72 (2) ◽

pp. 184-187 ◽

Cited By ~ 27

Author(s):

Ivica Ducic ◽

John M. Felder ◽

Neelam Khan ◽

Sojin Youn

Keyword(s):

Occipital Neuralgia ◽

Occipital Nerve ◽

Nerve Decompression ◽

Greater Occipital Nerve

Download Full-text

A simplified CT-guided approach for greater occipital nerve infiltration in the management of occipital neuralgia

European Radiology ◽

10.1007/s00330-015-3622-6 ◽

2015 ◽

Vol 25 (8) ◽

pp. 2512-2518 ◽

Cited By ~ 18

Author(s):

Adrian Kastler ◽

Yannick Onana ◽

Alexandre Comte ◽

Arnaud Attyé ◽

Jean-Louis Lajoie ◽

...

Keyword(s):

Occipital Neuralgia ◽

Ct Guided ◽

Occipital Nerve ◽

Greater Occipital Nerve

Download Full-text

Cooled Radiofrequency Ablation for Bilateral Greater Occipital Neuralgia

Case Reports in Neurological Medicine ◽

10.1155/2014/257373 ◽

2014 ◽

Vol 2014 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Tiffany Vu ◽

Akhil Chhatre

Keyword(s):

Radiofrequency Ablation ◽

Side Effects ◽

Medical Literature ◽

Current Medical ◽

Occipital Neuralgia ◽

Pulsed Radiofrequency ◽

Occipital Nerve ◽

Greater Occipital Nerve ◽

History Of

This report describes a case of bilateral greater occipital neuralgia treated with cooled radiofrequency ablation. The case is considered in relation to a review of greater occipital neuralgia, continuous thermal and pulsed radiofrequency ablation, and current medical literature on cooled radiofrequency ablation. In this case, a 35-year-old female with a 2.5-year history of chronic suboccipital bilateral headaches, described as constant, burning, and pulsating pain that started at the suboccipital region and radiated into her vertex. She was diagnosed with bilateral greater occipital neuralgia. She underwent cooled radiofrequency ablation of bilateral greater occipital nerves with minimal side effects and 75% pain reduction. Cooled radiofrequency ablation of the greater occipital nerve in challenging cases is an alternative to pulsed and continuous RFA to alleviate pain with less side effects and potential for long-term efficacy.

Download Full-text

Surgical Treatment of Greater Occipital Neuralgia by Neurolysis of the Greater Occipital Nerve and Sectioning of the Inferior Oblique Muscle

Spine ◽

10.1097/01.brs.0000112069.37836.2e ◽

2004 ◽

Vol 29 (7) ◽

pp. 828-832 ◽

Cited By ~ 59

Author(s):

Olivier Gille ◽

Benoit Lavignolle ◽

Jean-Marc Vital

Keyword(s):

Surgical Treatment ◽

Oblique Muscle ◽

Occipital Neuralgia ◽

Inferior Oblique Muscle ◽

Occipital Nerve ◽

Greater Occipital Nerve

Download Full-text

The Potential Roles of Cervical Plexus Abnormalities in Occipital Neuralgia: An Anatomic Variant Explored

Diagnostics ◽

10.3390/diagnostics12010139 ◽

2022 ◽

Vol 12 (1) ◽

pp. 139

Author(s):

Mitchell H. Mirande ◽

Heather F. Smith

Keyword(s):

Clinical Significance ◽

Degenerative Changes ◽

Clinical Implications ◽

Occipital Neuralgia ◽

Cervical Plexus ◽

Anatomical Variant ◽

Occipital Nerve ◽

Potential Source ◽

Greater Occipital Nerve ◽

Possible Cause

Occipital neuralgia (ON) is a condition defined as a headache characterized by paroxysmal burning and stabbing pain located in the distribution of the greater occipital nerve (GON), lesser occipital nerve (LON), or third occipital nerves (TON). This condition can be severely impairing in symptomatic patients and is known to have numerous etiologies deriving from various origins such as trauma, anatomical abnormalities, tumors, infections, and degenerative changes. This study reports four cases of a previously undescribed anatomical variant in which the (spinal) accessory nerve (SAN) fuses with the LON before piercing the sternocleidomastoid (SCM). The fusion of these two nerves and their route through the SCM points to a potential location for nerve compression within the SCM and, in turn, another potential source of ON. This anatomical presentation has clinical significance as it provides clinicians with another possible cause of ON to consider when diagnosing patients who present with complaints of a headache. Additionally, this study explores the prevalence of piercing anatomy of the LON and GAN and discusses their clinical implications.

Download Full-text

The Intramuscular Course of the Greater Occipital Nerve: Novel Findings with Potential Implications for Operative Interventions and Occipital Neuralgia

Surgical Neurology International ◽

10.4103/2152-7806.143743 ◽

2014 ◽

Vol 5 (1) ◽

pp. 155 ◽

Cited By ~ 5

Author(s):

AaronA Cohen-Gadol ◽

RShane Tubbs ◽

Koichi Watanabe ◽

Marios Loukas

Keyword(s):

Occipital Neuralgia ◽

Occipital Nerve ◽

Greater Occipital Nerve

Download Full-text

V2 Trigeminal Referred Pain from Chronic Occipital Neuralgia Caused by Entrapment of the Greater Occipital Nerve

Indian Journal of Neurosurgery ◽

10.1055/s-0038-1676662 ◽

2019 ◽

Vol 08 (01) ◽

pp. 076-080 ◽

Cited By ~ 2

Author(s):

Chang-ik Lee ◽

Byung-chul Son

Keyword(s):

Female Patient ◽

Afferent Input ◽

Referred Pain ◽

Occipital Neuralgia ◽

Upper Lip ◽

Occipital Nerve ◽

Burning Pain ◽

Trigeminal Pain ◽

Greater Occipital Nerve ◽

New Onset

AbstractAlthough entrapment of the greater occipital nerve (GON) is a well-known cause of occipital neuralgia, occurrence of referred hemifacial trigeminal pain involving V2 distribution from chronic occipital neuralgia is rare. A 67-year-old female patient with intermittent left-sided occipital neuralgia of 10-year duration presented with a new onset of left-sided hemifacial pain of 5-month duration. With aggravation of left-sided occipital neuralgia, continuous burning pain and paresthesia gradually developed in her left malar and periorbital area. They also spread to her left upper lip. Severe compression of the left GON by tendinous aponeurotic attachment of the trapezius was found intraoperatively. Decompression of the left GON from chronic entrapment resulted in immediate relief for her hemifacial pain and chronic occipital neuralgia. These findings provide clinical affirmation of the existence of trigeminal/cervical convergence and hypersensitivity. Chronic irritating afferent input of occipital neuralgia caused by entrapment of the GON seems to be associated with sensitization and hypersensitivity of the second-order neurons in the trigeminocervical complex receiving convergent input from dural and cervical structures. Referred trigeminal pain from chronic occipital neuralgia may extend to V2 in addition to V1 trigeminal distribution.

Download Full-text