From the Division of Aesthetic and Migraine Surgery, Global Medical Instituteand.
Department of Neurosciences, Division of Plastic Surgery, University of Padua.
Plast Reconstr Surg. 2023 Jan 1;151(1):169-177. doi: 10.1097/PRS.0000000000009777. Epub 2022 Oct 18.
Occipital neuralgia is a well-defined type of headache, and its treatment algorithm is still debated across medical specialties. From the analysis of the literature, it appears that surgical decompression of the occipital nerves is the most effective invasive approach to improve the quality of life of patients with occipital neuralgia refractory to medications. The authors describe here a minimally invasive nerve- and muscle-sparing technique to decompress the occipital nerves.
The results in terms of reduction of migraine days per month, use of medications, pain evaluation, and decrease in Migraine Headache Index were analyzed by means of a retrospective chart review of 87 patients who underwent nerve- and muscle-sparing surgical decompression of the greater and lesser monolateral or bilateral occipital nerves in their institution and were followed up for at least 12 months. The surgical technique is described in detail.
Surgical decompression significantly reduced occipital neuralgia burden (at least 50% improvement) in 91% of patients, with 45% reporting a complete remission of occipital pain. Days with pain per month decreased by 80%, chronic background pain intensity decreased by 81%, and pain intensity during crisis decreased by 76%. Accordingly, drug use dropped by approximately 70%. Only minor complications were reported in four patients.
The described technique could contribute to and further support surgical decompression as the first option among the invasive approaches to treat occipital neuralgia. Results corroborate previous findings, adding a less-invasive, nerve- and muscle-sparing approach.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
枕神经痛是一种明确的头痛类型，其治疗方案在各医学专业中仍存在争议。从文献分析来看，对于药物难治性枕神经痛患者，手术减压枕神经是改善生活质量最有效的有创方法。作者在这里描述了一种微创的神经和肌肉保留技术来减压枕神经。
通过对 87 例在该机构接受单侧或双侧大、小枕神经神经和肌肉保留减压手术并至少随访 12 个月的患者进行回顾性图表分析，分析了每月偏头痛天数减少、药物使用、疼痛评估和偏头痛头痛指数降低的结果。详细描述了手术技术。
手术减压显著减轻了 91%的患者的枕神经痛负担（至少改善 50%），45%的患者报告枕部疼痛完全缓解。每月疼痛天数减少了 80%，慢性背景疼痛强度降低了 81%，危机期间疼痛强度降低了 76%。相应地，药物使用减少了约 70%。仅 4 例患者报告有轻微并发症。
所描述的技术可以作为治疗枕神经痛的有创方法中的首选，进一步支持手术减压。结果与之前的发现相符，增加了一种微创、神经和肌肉保留的方法。
临床问题/证据水平：治疗，IV。
