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

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.

Trans-oral approach for occipital condyle biopsy: Case report and review of literature

Isolated occipital condyle lesions are commonly treated with empirical radiation, with the sole aim of relieving symptoms. Patients rarely undergo surgical biopsy, considering the morbidity associated with open surgery approaches and the importance of surrounding structures limiting the application of computed tomography (CT) scan or fluoroscopic percutaneous needle biopsies. We describe the case of a 66-year-old woman who was admitted on an emergency basis. Her clinical presentation included unilateral occipital headache and ipsilateral hypoglossal nerve palsy. Imaging revealed findings consistent with an isolated right occipital condyle lesion. In order to pursue a tissue diagnosis, essential to dictate medical management accurately, a minimally invasive biopsy of the occipital condyle through the trans-oral route was performed. Combined fluoroscopy, cone-bean CT and angiography allowed safe access to the lesion.

Endodermal cyst of the cranio-cervical junction

We report an extremely rare case of an endodermal cyst of the cranio-cervical junction located dorsally to the brainstem and upper cervical spine in a 27-year-old female presented with occipital headache, vertigo and pain in both shoulders. Neurological examination showed neck stiffness with bilateral XIth nerve palsy. Magnetic resonance imaging revealed a cystic lesion at the cranio-cervical junction and slight compression of the brain stem. The lesion was totally removed through the posterior approach. The histological diagnosis was endodermal cyst. To our knowledge, the only one such case has been reported in the literature.

Symptomatic Cerebral Ependymal Cyst : A Case Report

Cerebral ependymal cyst is a rare benign neuroepithelial cyst. We report a case of cerebral ependymal cyst in a 62-year-old lady who presented with status epilepticus. She gave history of progressive right occipital headache over a year. Magnetic Resonance Imaging of the brain showed a large occipital cyst. She underwent a right craniotomy, deroofing of the cyst and insertion of Ommaya catheter. The clinicopathological aspects of the cyst are discussed.

Acute subdural haemorrhage complicating cerebral venous thrombosis in a patient with protein C deficiency

Cerebral venous thrombosis (CVT) directly causing subdural haemorrhage (SDH) is a rare entity. We present a case of an 18-year-old female patient who presented with severe occipital headache. Neuroimaging showed acute SDH and CVT. She was eventually discovered to have underlying protein C deficiency. She was treated with anticoagulation and made an uneventful recovery. We aim to highlight the epidemiology, risk factors and aetiopathogenesis of CVT. We have included a literature review of previously described 13 case studies/reports describing SDH associated with CVT and a brief discussion of the dilemmas associated with management.

Unusual symptoms of Thornwaldt’s cyst: a case report

<p>Thornwaldt’s cyst also known as bursa pharyngeal embryonalis which is formed by traction of notochord at the retropharyngeal wall at the site of contact. It is present in the midline, at the junction between nasopharyngeal vault and posterior pharyngeal wall. The bursa can extend upward and backward above the limit of superior constrictor muscle fibres. This bursa when infected becomes seat of inflammation and cyst formation occurred. The well-known Thornwaldt’s cyst occurs as a result of obstruction of orifice of the bursa and is different from cyst of Rathke’s pouch. Thornwaldt’s cyst is usually asymptomatic but more than 1-2 cm may become symptomatic. Symptoms that commonly seen are halitosis, nasal discharge, nasal obstruction, epistaxis, prevertebral spasm, and rarely occipital headache and obstruction of Eustachian tube can occur. The diagnosis usually incidental as a part of a nasal endoscopic examination or radiological and endoscopic examination which is used to diagnose the cyst. On examination it appears as smooth mass with a central dimple. In this case report young female present with difficulty in swallowing, occipital headache, halitosis and fever. Initially she was managed conservatively when the cyst was resolved then it was marspupizied by transoral approach, with uneventful postoperative period. Other approaches for excision or marsupialization in symptomatic cases are endoscopic or transpalatal using powdered instrumentation.</p>