Surgical treatment of greater occipital neuralgia by neurolysis of the greater occipital nerve and sectioning of the inferior oblique muscle.

OBJECTIVES

To evaluate a new surgical treatment consisting of neurolysis of the great occipital nerve and section of the inferior oblique muscle. DESIGN.: A retrospective study of 10 patients operated for greater occipital neuralgia.

SUMMARY AND BACKGROUND DATA

This technique is based on a previous anatomic cadaver study. The greater occipital nerve is stretched by the inferior oblique muscle of the head during flexion of the cervical spine. Sectioning this muscle relaxes the greater occipital nerve. With this procedure, the authors systematically associate release of the nerve down to the inferior edge of the inferior oblique muscle.

METHODS

A retrospective study was conducted of 10 patients operated on from January 1998 to December 1999 for greater occipital neuralgia. All the patients had pain exacerbated by flexion of the cervical spine. The average age of the patients was 62 years. The mean follow-up of the series was 37 months. The results of the treatment were assessed according to three criteria: 1) degree of pain on a Visual Analogue Scale before surgery, at 3 months, and at last follow-up; 2) consumption of analgesics before surgery and at follow-up; and 3) the degree of patient satisfaction at follow-up.

RESULTS

In three cases, anatomic anomalies were found. One patient had hypertrophy of the venous plexus around C2. In another, the nerve penetrated the inferior oblique muscle. The third had degenerative C1-C2 osteoarthritis requiring associated C1-C2 arthrodesis. The mean Visual Analogue Scale score was 80/100 before surgery and 20/100 at last follow-up. Consumption of analgesics decreased in all patients. Seven of the 10 patients were very satisfied or satisfied with the operation.

CONCLUSION

This surgical technique gives good results on greater occipital neuralgia if patients are well chosen. Nerve release is justified by the frequency of associated anatomic abnormalities.