Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon, USA.
Operative Care Division, Portland Veterans Administration, Portland, Oregon, USA.
Oper Neurosurg (Hagerstown). 2023 Mar 1;24(3):e148-e152. doi: 10.1227/ons.0000000000000511. Epub 2022 Nov 18.
Occipital neuralgia is a painful condition that is believed to occur from processes that affect the greater, lesser, or third occipital nerves. Diagnosis is often made with a combination of classical symptoms, tenderness over the occipital region, and response to occipital nerve blocks. Cervical computed tomography or MRI may be obtained in multiple positions to detect any impingement. Diagnosis can be made with MRI tractography. Nonsurgical treatments include local anesthetic and steroid injections, anticonvulsant medications, botulinum toxin injections, physical therapy, acupuncture, transcutaneous electrical stimulation, cryoneurolysis, and radiofrequency ablation. Surgical treatments include greater occipital nerve decompression, C2 root section, intradural dorsal root rhizotomy, C1-2 fusion, and occipital nerve stimulation. Although stimulation has been favored in the past decade, complications and maintenance of the devices have led us to return to C2 ganglionectomy.
To report on the use of a minimally invasive technique for C2 ganglionectomy to treat occipital neuralgia.
Review demographic, surgery, and outcome data of a minimally invasive C2 root ganglionectomy used to treat to 2 patients with occipital neuralgia.
We report on 2 patients with clinically stereotypical unilateral occipital neuralgia confirmed by greater occipital nerve block, but with no imaging correlate. Both were successfully managed by C2 ganglionectomy through an 18-mm tubular retractor and outpatient surgery. Accompanying text, still photographs, and video describe the technique in detail.
Minimally invasive C2 ganglionectomy can be used to successfully treat occipital neuralgia.
枕神经痛是一种疼痛的病症，据信是由影响大、小或第三枕神经的过程引起的。诊断通常是结合经典症状、枕区压痛和枕神经阻滞的反应来做出的。颈椎 CT 或 MRI 可在多个位置获得以检测任何压迫。诊断可以通过 MRI 示踪来完成。非手术治疗包括局部麻醉和皮质类固醇注射、抗惊厥药物、肉毒杆菌毒素注射、物理疗法、针灸、经皮电刺激、冷冻神经松解术和射频消融术。手术治疗包括枕大神经减压、C2 神经根切断术、硬脊膜内背根神经节切断术、C1-2 融合术和枕神经刺激术。尽管在过去十年中刺激术受到青睐，但设备的并发症和维护问题导致我们又回到了 C2 神经节切除术。
报告一种微创技术用于 C2 神经节切除术治疗枕神经痛。
回顾性分析 2 例采用微创 C2 神经根切断术治疗枕神经痛的患者的人口统计学、手术和结果数据。
我们报告了 2 例具有典型单侧枕神经痛的患者，这些疼痛通过大枕神经阻滞得到证实，但没有影像学相关证据。通过 18mm 管状牵开器和门诊手术，这 2 例患者均成功地接受了 C2 神经节切除术治疗。相关文字、静态照片和视频详细描述了该技术。
微创 C2 神经节切除术可成功治疗枕神经痛。
